Healthcare Provider Details

I. General information

NPI: 1568439230
Provider Name (Legal Business Name): DAVID W LAWLER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 MAIN ST
HOPE VALLEY RI
02832-1920
US

IV. Provider business mailing address

211 RIDGE DR
EXETER RI
02822-2401
US

V. Phone/Fax

Practice location:
  • Phone: 401-539-2461
  • Fax: 401-539-2663
Mailing address:
  • Phone: 401-539-2461
  • Fax: 401-539-2663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00040
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: