Provider Demographics
NPI:1306860804
Name:BENDER, LAWRENCE WILLIAM (DO)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:WILLIAM
Last Name:BENDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 GOV G C PEERY HWY
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2197
Mailing Address - Country:US
Mailing Address - Phone:276-596-6659
Mailing Address - Fax:276-596-6658
Practice Address - Street 1:6719 GOV G C PEERY HWY
Practice Address - Street 2:SUITE 1800
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2197
Practice Address - Country:US
Practice Address - Phone:276-596-6659
Practice Address - Fax:276-596-6658
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201959208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1306860804Medicaid
VAE79102Medicare UPIN