MEDICARE: KEITH WILLIS LAWHORN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	0101048300	VA

General Provider Information

NPI Number	:	1083614218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH WILLIS LAWHORN MD

Provider Business Mailing Address
First Line	:	PO BOX 75868
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21275-5868
Country	:	US
Telephone Number	:	703-383-6469
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 JOSEPH SIEWICK DR
Second Line	:	SUITE 100
City	:	FAIRFAX
State	:	VA
Zip	:	22033-1756
Country	:	US
Telephone Number	:	703-810-5223
Fax Number	:	703-810-5403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	10/28/2020

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