Provider Demographics
NPI:1831390681
Name:KING, LAWRENCE F (PA-C)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:F
Last Name:KING
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 CHESTNUT ST
Mailing Address - Street 2:SUITE T-150
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5127
Mailing Address - Country:US
Mailing Address - Phone:215-955-7246
Mailing Address - Fax:215-923-5086
Practice Address - Street 1:834 CHESTNUT ST
Practice Address - Street 2:SUITE T-150
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5127
Practice Address - Country:US
Practice Address - Phone:215-955-7246
Practice Address - Fax:215-923-5086
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002302L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA076501Medicare PIN