Healthcare Provider Details

I. General information

NPI: 1417084989
Provider Name (Legal Business Name): NATHAN LAWRENCE CENTERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 S STATE ST
DOVER DE
19901-7314
US

IV. Provider business mailing address

156 S STATE ST
DOVER DE
19901-7314
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-2380
  • Fax: 302-691-1100
Mailing address:
  • Phone: 302-674-2380
  • Fax: 302-691-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberCI0005952
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: