Provider Demographics
NPI:1316925142
Name:DEUBER, LAWRENCE C (PAC)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:C
Last Name:DEUBER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BEECH DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403
Mailing Address - Country:US
Mailing Address - Phone:610-279-6100
Mailing Address - Fax:610-279-0670
Practice Address - Street 1:50 BEECH DR
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19403-5421
Practice Address - Country:US
Practice Address - Phone:610-279-6100
Practice Address - Fax:610-279-0670
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000499L363A00000X
PAMA003514L363AM0700X
DEC50000327363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000033361Medicaid
DE013310D04Medicare ID - Type Unspecified
DE1000033361Medicaid