Healthcare Provider Details

I. General information

NPI: 1104764729
Provider Name (Legal Business Name): ADAM LAWLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 MINERAL SPRING AVE
NORTH PROVIDENCE RI
02904-4042
US

IV. Provider business mailing address

560 W COLONY RD
RIPON CA
95366-9452
US

V. Phone/Fax

Practice location:
  • Phone: 401-353-0800
  • Fax:
Mailing address:
  • Phone: 209-305-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: