Provider Demographics
NPI:1649288937
Name:REID, LAWRENCE M (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:M
Last Name:REID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 212110
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33421-2110
Mailing Address - Country:US
Mailing Address - Phone:561-204-5230
Mailing Address - Fax:561-204-5232
Practice Address - Street 1:275 GUTHRIE DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-8115
Practice Address - Country:US
Practice Address - Phone:877-204-4155
Practice Address - Fax:877-213-5232
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD425989207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012390590001Medicaid
FL049744400Medicaid
PA1013081650Medicaid
PA091000T8YMedicare ID - Type Unspecified