Provider Demographics
NPI:1306999206
Name:BEHNEY, LAURENCE WALN (MD)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:WALN
Last Name:BEHNEY
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 100
Mailing Address - Street 2:
Mailing Address - City:BEECH GROVE
Mailing Address - State:IN
Mailing Address - Zip Code:46107-0100
Mailing Address - Country:US
Mailing Address - Phone:317-859-1090
Mailing Address - Fax:317-859-3322
Practice Address - Street 1:1600 ALBANY ST
Practice Address - Street 2:SOUTH ENTRANCE GROUND FLOOR
Practice Address - City:BEECH GROVE
Practice Address - State:IN
Practice Address - Zip Code:46107-1541
Practice Address - Country:US
Practice Address - Phone:317-859-1090
Practice Address - Fax:317-859-3322
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043611A207R00000X, 207RG0300X, 207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01043611BOtherCSR
IN000000027961OtherM PLAN
IN000000341213OtherANTHEM
IN10780253OtherCAQH
IN10780253OtherCAQH
INAB3293456OtherDEA
IN899970OMedicare PIN