Provider Demographics
NPI:1881789816
Name:SHAMPAIN, LAWRENCE RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:RICHARD
Last Name:SHAMPAIN
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 1:480 WAKEFIELD DR
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1611
Mailing Address - Country:US
Mailing Address - Phone:732-548-2097
Mailing Address - Fax:732-548-4591
Practice Address - Street 1:32 WERNIK PL STE B
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2467
Practice Address - Country:US
Practice Address - Phone:732-548-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0546522084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4144007Medicaid
NJ0942405Medicaid
NJ31-4011Medicare PIN
NJC86407Medicare UPIN
NJ4144007Medicaid