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General NPI Number Information
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NPI Number | 1972833812
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Entity Type | Organization
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Legal Business Name | FALLS MEDICAL GROUP LLC
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Dates
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Enumeration Date | 12/27/2009
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Last Update Date | 12/27/2010
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Provider Practice Location Address
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Address Line | 821 N EUTAW ST SUITE 305
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City | BALTIMORE
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State | MD
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Zip | 21201
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Country | US
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Telephone | 410-530-8764
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Fax | 877-335-6202
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Provider Business Mailing Address
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Address Line | 821 N EUTAW ST SUITE 305
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City | BALTIMORE
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State | MD
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Zip | 21201-4648
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Country | US
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Telephone | 410-530-8764
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Fax | 877-335-6202
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. MICHAEL THOMAS LAWRENCE
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Credential | MD
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Telephone | 410-530-8764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D51148
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License Number State | MD
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