Healthcare Provider Details

I. General information

NPI: 1154043057
Provider Name (Legal Business Name): MADISON ELIZABETH LAWRENCE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 EISENHOWER DR
HANOVER PA
17331-5248
US

IV. Provider business mailing address

1861 POWDER MILL ROAD ATTN MEDICAL STAFF OFFICE
YORK PA
17402-4723
US

V. Phone/Fax

Practice location:
  • Phone: 717-633-0031
  • Fax: 717-630-1085
Mailing address:
  • Phone: 717-718-2041
  • Fax: 717-747-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA006468
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA064067
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: