Provider Demographics
NPI:1457431140
Name:WATKINS, LAWRENCE BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:BERNARD
Last Name:WATKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6335 ALISSA LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3456
Mailing Address - Country:US
Mailing Address - Phone:614-755-9194
Mailing Address - Fax:614-755-9846
Practice Address - Street 1:3433 AGLER RD
Practice Address - Street 2:SUITE 1300
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3387
Practice Address - Country:US
Practice Address - Phone:614-755-9194
Practice Address - Fax:614-476-8748
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35046248W208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0534916Medicaid
OHCO3223Medicare UPIN