Provider Demographics
NPI:1740317239
Name:LAWRENCE, LESLIE STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:STEPHEN
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:110 8TH STREET
Mailing Address - Street 2:ACADEMY HALL, SUITE 3200
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180
Mailing Address - Country:US
Mailing Address - Phone:518-276-6287
Mailing Address - Fax:518-276-8573
Practice Address - Street 1:110 8TH STREET
Practice Address - Street 2:ACADEMY HALL, SUITE 3200
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180
Practice Address - Country:US
Practice Address - Phone:518-276-6287
Practice Address - Fax:518-276-8573
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY175556-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBL8683749OtherDEA #
NYE42301Medicare UPIN