Provider Demographics
NPI:1194719757
Name:SCHOCH, LAWRENCE HASTINGS (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:HASTINGS
Last Name:SCHOCH
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 1:122 ELMHURST LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2912
Mailing Address - Country:US
Mailing Address - Phone:812-273-2860
Mailing Address - Fax:866-879-4830
Practice Address - Street 1:2580 MICHIGAN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-2491
Practice Address - Country:US
Practice Address - Phone:812-265-6222
Practice Address - Fax:866-879-4830
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055597A207W00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200379700Medicaid
IN225050AMedicare ID - Type Unspecified
IN200379700Medicaid