Provider Demographics
NPI:1295711323
Name:LAWLOR, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:LAWLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-8858
Mailing Address - Fax:617-726-2167
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:PEDIATRIC SURGERY WRN 11
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-8858
Practice Address - Fax:617-726-2167
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2024-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA74011208600000X, 2086S0120X
MT740152086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22667OtherBCBS MA
MA0101524Medicaid
MA074011OtherTUFTS HEALTH PLAN
MAJ22667OtherBCBS MA
MA074011OtherTUFTS HEALTH PLAN