=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548459290
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAWRENCE P. MCADAM, M.D., MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2007
-----------------------------------------------------
Last Update Date | 12/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 227 W JANSS RD SUITE 300
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91360-1848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-497-7815
-----------------------------------------------------
Fax | 805-373-0167
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 227 W JANSS RD SUITE 300
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91360-1848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-497-7815
-----------------------------------------------------
Fax | 805-373-0167
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LAWRENCE P MCADAM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 805-497-7815
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | A023409
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------