Provider Demographics
NPI:1295723757
Name:FECHTNER, LAWRENCE M (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:M
Last Name:FECHTNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WESCOTT DRIVE
Mailing Address - Street 2:STE 102
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822
Mailing Address - Country:US
Mailing Address - Phone:908-237-1148
Mailing Address - Fax:908-237-1318
Practice Address - Street 1:2100 WESCOTT DRIVE
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822
Practice Address - Country:US
Practice Address - Phone:908-237-1148
Practice Address - Fax:908-237-1318
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64361208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG11474Medicare UPIN
NJ887265Medicare PIN
NJ887265BSDMedicare ID - Type UnspecifiedMEDICARE#