Provider Demographics
NPI:1932197803
Name:DAVIS, LAWRENCE M (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 METRO CENTER BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1785
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-453-8220
Practice Address - Street 1:125 METRO CENTER BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1785
Practice Address - Country:US
Practice Address - Phone:401-432-2520
Practice Address - Fax:401-453-8220
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI86532085R0202X
RIMD086532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
008653OtherBLUESHIELD
1988OtherNHPRI
007005846OtherHOSPITALPIN
16-00203OtherUNITEDHEALTHPLANS
720055401OtherCIGNA
008653OtherTUFTS
3200361OtherMASSMEDICAID
7005839OtherRIMEDICALASSISTANCE
241361OtherRIHPILGRIM
300072587OtherRAILROAD MEDICARE
3200361OtherHEALTHYSTART
400990OtherBLUECHIP