Provider Demographics
NPI:1154793263
Name:SEVERINO, LAWRENCE JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOHN
Last Name:SEVERINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:PROF
Other - First Name:LAWRENCE
Other - Middle Name:JOHN
Other - Last Name:SEVERINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 SAXON WOODS RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-4821
Mailing Address - Country:US
Mailing Address - Phone:914-949-6344
Mailing Address - Fax:914-948-5563
Practice Address - Street 1:200 SAXON WOODS RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-4821
Practice Address - Country:US
Practice Address - Phone:914-949-6344
Practice Address - Fax:914-948-5563
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY90354207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology