Provider Demographics
NPI:1427055946
Name:PEZOR, LAURENCE JOHN JR (MD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:JOHN
Last Name:PEZOR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:808 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-1398
Mailing Address - Country:US
Mailing Address - Phone:410-479-2650
Mailing Address - Fax:833-908-2283
Practice Address - Street 1:808 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1398
Practice Address - Country:US
Practice Address - Phone:410-479-2650
Practice Address - Fax:833-908-2283
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00420322084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD609550001Medicaid
MD609550002Medicaid
MD609550004Medicaid