Provider Demographics
NPI:1154376887
Name:LAWRENZ, ANITA G (MD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:G
Last Name:LAWRENZ
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 1:2104 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-3260
Mailing Address - Country:US
Mailing Address - Phone:330-923-3502
Mailing Address - Fax:330-923-3507
Practice Address - Street 1:2104 FRONT ST
Practice Address - Street 2:SUITE B
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3260
Practice Address - Country:US
Practice Address - Phone:330-923-3502
Practice Address - Fax:330-923-3507
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35070273207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2009703Medicaid
OHH083320Medicare PIN