Provider Demographics
NPI:1316987712
Name:PASQUINELLI, LAWRENCE M (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:M
Last Name:PASQUINELLI
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 1:171 KEMPSVILLE RD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4700
Mailing Address - Country:US
Mailing Address - Phone:757-668-6500
Mailing Address - Fax:
Practice Address - Street 1:171 KEMPSVILLE RD
Practice Address - Street 2:BUILDING B
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4700
Practice Address - Country:US
Practice Address - Phone:757-668-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051140208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
010159016OtherVA PREMIER
176576OtherANTHEM
VI010159016Medicaid
35236OtherOPTIMA
2133287OtherMDIPA/MAMSI
NC890627WMedicaid
541778786001OtherTRICARE
F85082Medicare UPIN