Healthcare Provider Details

I. General information

NPI: 1992730642
Provider Name (Legal Business Name): DANIEL C. LAWRENCE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 MCLAWS CIR SUITE 105
WILLIAMSBURG VA
23185-5674
US

IV. Provider business mailing address

301 CONCOURSE BLVD SUITE 210
GLEN ALLEN VA
23059-5643
US

V. Phone/Fax

Practice location:
  • Phone: 757-941-5600
  • Fax: 757-564-0557
Mailing address:
  • Phone: 804-433-1040
  • Fax: 804-553-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101033289
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: