Healthcare Provider Details

I. General information

NPI: 1518933415
Provider Name (Legal Business Name): MICHAEL LAWRENCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N GREENE ST
SNOW HILL NC
28580-1412
US

IV. Provider business mailing address

PO BOX 658
SNOW HILL NC
28580-0658
US

V. Phone/Fax

Practice location:
  • Phone: 252-747-2921
  • Fax: 252-747-4915
Mailing address:
  • Phone: 252-747-8162
  • Fax: 252-747-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2002-00393
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: