Provider Demographics
NPI:1154043057
Name:LAWRENCE, MADISON ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ELIZABETH
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:689 YORKTOWN RD
Practice Address - Street 2:
Practice Address - City:LEWISBERRY
Practice Address - State:PA
Practice Address - Zip Code:17339-9258
Practice Address - Country:US
Practice Address - Phone:717-932-4050
Practice Address - Fax:717-932-8072
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA064067363A00000X
PAOA006468363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty