MEDICARE: DR. TIMOTHY LAWRENCE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	167977	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0004215975	OTHER	NY	AETNA
2	2725	OTHER	NY	BLUE CROSS BLUE SHIELD
3	102521EU	OTHER	NY	PREFERRED CARE

General Provider Information

NPI Number	:	1528004223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY LAWRENCE M.D.

Provider Business Mailing Address
First Line	:	55 PICKWICK DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-4103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 S CLINTON AVE
Second Line	:	SUITE 445
City	:	ROCHESTER
State	:	NY
Zip	:	14618-5720
Country	:	US
Telephone Number	:	585-473-5140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	07/08/2007

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