Provider Demographics
NPI:1194726315
Name:WILBERS, LAWRENCE L (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:L
Last Name:WILBERS
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:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-0550
Mailing Address - Country:US
Mailing Address - Phone:740-687-5164
Mailing Address - Fax:740-654-1417
Practice Address - Street 1:401 N EWING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3372
Practice Address - Country:US
Practice Address - Phone:740-687-8141
Practice Address - Fax:740-687-8973
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-046253207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0623856Medicaid
OH0623856Medicaid
OH0832043Medicare PIN