Provider Demographics
NPI:1154313179
Name:MARKMAN, LAWRENCE MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:MICHAEL
Last Name:MARKMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 WOODSTREAM LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3300
Mailing Address - Country:US
Mailing Address - Phone:302-598-5650
Mailing Address - Fax:
Practice Address - Street 1:202 WOODSTREAM LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3300
Practice Address - Country:US
Practice Address - Phone:302-598-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06191500207Q00000X, 207QG0300X
PAMD057869L207Q00000X, 207QG0300X
DEC1-0001808207QG0300X
DEC10001808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000V13M67Medicare ID - Type Unspecified
B66498Medicare UPIN