Healthcare Provider Details

I. General information

NPI: 1548255235
Provider Name (Legal Business Name): LAWRENCE HANKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 STATE RD
KITTERY ME
03904-1519
US

IV. Provider business mailing address

139 STATE RD
KITTERY ME
03904-1519
US

V. Phone/Fax

Practice location:
  • Phone: 207-439-2007
  • Fax: 207-439-2007
Mailing address:
  • Phone: 207-439-2007
  • Fax: 207-439-2007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number015099
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: