=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295711323
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID LAWLOR MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2005
-----------------------------------------------------
Last Update Date | 12/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 FRUIT ST PEDIATRIC SURGERY WRN 11
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02114-2696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-726-8858
-----------------------------------------------------
Fax | 617-726-2167
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9142 MASS GENERAL PHYSICIAN ORGANIZATION
-----------------------------------------------------
City | CHARLESTOWN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02129-9142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-726-8858
-----------------------------------------------------
Fax | 617-726-2167
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 74011
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2086S0120X
-----------------------------------------------------
Taxonomy Name | Pediatric Surgery Physician
-----------------------------------------------------
License Number | 74015
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2086S0120X
-----------------------------------------------------
Taxonomy Name | Pediatric Surgery Physician
-----------------------------------------------------
License Number | 74011
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------