Provider Demographics
NPI:1215985833
Name:LAWLOR, KEAN B (MD)
Entity type:Individual
Prefix:DR
First Name:KEAN
Middle Name:B
Last Name:LAWLOR
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 1:3216 NE 45TH PLACE
Mailing Address - Street 2:STE 203
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105
Mailing Address - Country:US
Mailing Address - Phone:206-525-1168
Mailing Address - Fax:206-525-1169
Practice Address - Street 1:3216 NE 45TH PLACE
Practice Address - Street 2:STE 203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105
Practice Address - Country:US
Practice Address - Phone:206-525-1168
Practice Address - Fax:206-525-1169
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD30728207N00000X, 207ND0101X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1109735Medicaid
WA1109735Medicaid
F58152Medicare UPIN