MEDICARE: PATRICK BERWYN LAWRENCE M.D.

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	207QA0505X	Adult Medicine Physician	A20149	CA
2	207R00000X	Internal Medicine Physician	A20149	CA
3	207V00000X	Obstetrics & Gynecology Physician	A20149	CA
4	208000000X	Pediatrics Physician	A20149	CA
5	207Q00000X	Family Medicine Physician	A20149	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A20149	OTHER	CA	LICENSE

General Provider Information

NPI Number	:	1578625364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK BERWYN LAWRENCE M.D.

Provider Business Mailing Address
First Line	:	1061 E VERNON AVE
Second Line	:	SUITE F
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-3772
Country	:	US
Telephone Number	:	323-233-9686
Fax Number	:	323-233-0595

Provider Business Practice Location Address
First Line	:	1061 E VERNON AVE
Second Line	:	SUITE F
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-3772
Country	:	US
Telephone Number	:	323-233-9686
Fax Number	:	323-233-0595

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	10/16/2017

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Directions to “ PATRICK BERWYN LAWRENCE M.D.” Practice Location

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