Provider Demographics
NPI:1386737195
Name:YELLEN, LAWRENCE ELLIOTT (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ELLIOTT
Last Name:YELLEN
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:POST OFFICE BOX 1043
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-1043
Mailing Address - Country:US
Mailing Address - Phone:508-879-3260
Mailing Address - Fax:508-620-9263
Practice Address - Street 1:803 CONCORD STREET
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4602
Practice Address - Country:US
Practice Address - Phone:508-879-3260
Practice Address - Fax:508-620-9263
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA32401207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB18156OtherBLUE CROSS
0010016OtherNEIGHBORHOOD
032401OtherSECURE HORIZONS
4052509OtherAETNA
D442OtherHARVARD PILGRIM
032401OtherTUFTS
MA2011654Medicaid
0010016OtherNEIGHBORHOOD
0010016OtherNEIGHBORHOOD