Provider Demographics
NPI:1952378937
Name:TOMACK, LAWRENCE STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:STEVEN
Last Name:TOMACK
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 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 HIGH ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3198
Practice Address - Country:US
Practice Address - Phone:570-321-2619
Practice Address - Fax:570-321-2670
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040881E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010097740001Medicaid
PA1489362OtherUNITEDHEALTHCARE
PA515508OtherHIGHMARK BLUE SHIELD
PAB42336OtherHEALTHAMERICA
PA080443OtherFIRST PRIORITY HEALTH
PA547104OtherAETNA
PA50054360OtherCAPITAL BLUE CROSS
PA1010097740001Medicaid
PA515508OtherHIGHMARK BLUE SHIELD
PAB42336OtherHEALTHAMERICA