Provider Demographics
NPI:1881731404
Name:PERIN, LAWRENCE ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ANTHONY
Last Name:PERIN
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 1:1305 BARNARD ST
Mailing Address - Street 2:# 29
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-6746
Mailing Address - Country:US
Mailing Address - Phone:215-519-1832
Mailing Address - Fax:
Practice Address - Street 1:1305 BARNARD ST
Practice Address - Street 2:# 29
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-6746
Practice Address - Country:US
Practice Address - Phone:215-519-1832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058850207Q00000X
GA77146207Q00000X
PAMD035068L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC-30547Medicare UPIN