Provider Demographics
NPI:1295869543
Name:LAWSON, LAURA NELSON (DO)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:NELSON
Last Name:LAWSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:NELSON
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:230 COSTELLO DR STE 210
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-4686
Mailing Address - Country:US
Mailing Address - Phone:540-450-5743
Mailing Address - Fax:540-869-3524
Practice Address - Street 1:230 COSTELLO DR STE 210
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-4686
Practice Address - Country:US
Practice Address - Phone:540-450-5743
Practice Address - Fax:540-869-3524
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00859207Q00000X
VA0102202773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0299936OtherFEDERAL DEA
NC7907392Medicaid
NC2403757Medicare PIN