Provider Demographics
NPI:1124100565
Name:LAWRENCE, NAOMI (MD)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST STE SW200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1155
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:10000 SAGEMORE DR
Practice Address - Street 2:SUITE 10103
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3944
Practice Address - Country:US
Practice Address - Phone:856-596-3040
Practice Address - Fax:856-735-6497
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA59796207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
28422OtherUNIVERSITY HEALTHPLAN
1242498OtherUNITED HEALTHCARE
NJ6013201Medicaid
0685481000OtherAMERIHEALTH, KEYSTONE, IBC
110084269OtherRR MEDICARE
P3597614OtherOXFORD
4579756OtherAETNA
8149041OtherCIGNA
4579756OtherAETNA
8149041OtherCIGNA