Provider Demographics
NPI:1801883012
Name:LAWLOR, JOSEPH CONRAD (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CONRAD
Last Name:LAWLOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3371 KEMP RD
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2514
Mailing Address - Country:US
Mailing Address - Phone:937-458-4200
Mailing Address - Fax:937-458-4209
Practice Address - Street 1:3371 KEMP RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431
Practice Address - Country:US
Practice Address - Phone:937-458-4200
Practice Address - Fax:937-458-4209
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34.004775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0757202Medicaid
H331650Medicare PIN