Healthcare Provider Details

I. General information

NPI: 1508844366
Provider Name (Legal Business Name): LAWRENCE M. SHALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 VOLVO PKWY SUITE # 300
CHESAPEAKE VA
23320-1609
US

IV. Provider business mailing address

637 KINGSBOROUGH SQ STE D
CHESAPEAKE VA
23320-4944
US

V. Phone/Fax

Practice location:
  • Phone: 757-321-3383
  • Fax: 757-321-3332
Mailing address:
  • Phone: 757-762-3582
  • Fax: 757-664-9930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101040335
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: