Healthcare Provider Details

I. General information

NPI: 1841215522
Provider Name (Legal Business Name): S LAWSON DERBY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HERRICK ST STE 101 MEDICAL GROUP INC
BEVERLY MA
01915-3012
US

IV. Provider business mailing address

77 HERRICK ST SUITE 101
BEVERLY MA
01915-3012
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-4110
  • Fax: 978-232-7057
Mailing address:
  • Phone: 978-927-4110
  • Fax: 978-232-7057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number216949
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: