Provider Demographics
NPI:1194139394
Name:LAWSON-JOHN, TOLULOPE
Entity type:Individual
Prefix:
First Name:TOLULOPE
Middle Name:
Last Name:LAWSON-JOHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:102
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1221
Mailing Address - Country:US
Mailing Address - Phone:443-725-4930
Mailing Address - Fax:
Practice Address - Street 1:312 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:102
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1221
Practice Address - Country:US
Practice Address - Phone:443-725-4930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR188410363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily