Provider Demographics
NPI:1699885673
Name:WEIL, LAWRENCE RICHARD (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:RICHARD
Last Name:WEIL
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 1:350 BURROUGHS RD
Mailing Address - Street 2:
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719-1916
Mailing Address - Country:US
Mailing Address - Phone:978-263-5497
Mailing Address - Fax:978-263-1226
Practice Address - Street 1:350 BURROUGHS RD
Practice Address - Street 2:
Practice Address - City:BOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01719-1916
Practice Address - Country:US
Practice Address - Phone:978-263-5497
Practice Address - Fax:978-263-1226
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA546022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3027287Medicaid
MAA58138Medicare UPIN
MA3027287Medicaid