Healthcare Provider Details

I. General information

NPI: 1427055946
Provider Name (Legal Business Name): LAURENCE JOHN PEZOR JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 S 5TH AVE
DENTON MD
21629-1398
US

IV. Provider business mailing address

808 S 5TH AVE
DENTON MD
21629-1398
US

V. Phone/Fax

Practice location:
  • Phone: 410-479-2650
  • Fax: 833-908-2283
Mailing address:
  • Phone: 410-479-2650
  • Fax: 833-908-2283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0042032
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0042032
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: