Healthcare Provider Details

I. General information

NPI: 1295711323
Provider Name (Legal Business Name): DAVID LAWLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST PEDIATRIC SURGERY WRN 11
BOSTON MA
02114-2696
US

IV. Provider business mailing address

PO BOX 9142 MASS GENERAL PHYSICIAN ORGANIZATION
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-8858
  • Fax: 617-726-2167
Mailing address:
  • Phone: 617-726-8858
  • Fax: 617-726-2167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number74011
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number74015
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number74011
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: