Provider Demographics
NPI:1841255023
Name:ST. CLAIR, R. LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:R. LAWRENCE
Middle Name:
Last Name:ST. CLAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GILSON RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2909
Mailing Address - Country:US
Mailing Address - Phone:781-235-7720
Mailing Address - Fax:781-235-7720
Practice Address - Street 1:11 GILSON RD
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2909
Practice Address - Country:US
Practice Address - Phone:781-235-7720
Practice Address - Fax:781-235-7720
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA381812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2061872Medicaid
MA2061872Medicaid
MAB33467Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER