Provider Demographics
NPI:1285759266
Name:LAURENCE S. WOHL, M.D.P.C.
Entity type:Organization
Organization Name:LAURENCE S. WOHL, M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WOHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-587-5252
Mailing Address - Street 1:166 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2803
Mailing Address - Country:US
Mailing Address - Phone:508-587-5252
Mailing Address - Fax:508-427-4318
Practice Address - Street 1:166 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2803
Practice Address - Country:US
Practice Address - Phone:508-587-5252
Practice Address - Fax:508-427-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2032937Medicaid
MA708384OtherTUFTS
MAC20209OtherBLUE SHIELD-INDIVIDUAL ID
MA1891749669OtherNPI-INDIVIDUAL ID NUMBER
MA6055OtherHARVARDPILGRIM
MA6055OtherHARVARDPILGRIM
MA1891749669OtherNPI-INDIVIDUAL ID NUMBER