Provider Demographics
NPI:1992730642
Name:LAWRENCE, DANIEL C (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:C
Last Name:LAWRENCE
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 1:301 CONCOURSE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5643
Mailing Address - Country:US
Mailing Address - Phone:804-433-1040
Mailing Address - Fax:804-553-3860
Practice Address - Street 1:263 MCLAWS CIR
Practice Address - Street 2:SUITE 105
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5674
Practice Address - Country:US
Practice Address - Phone:757-941-5600
Practice Address - Fax:757-564-0557
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101033289207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA57537OtherSOUTHERN HEALTH SERVICES
VA4065064OtherAETNA HMO
VA010017246Medicaid
VA101719OtherANTHEM BCBS OF VA
VA080191096OtherRAILROAD MEDICARE
VA4065064OtherAETNA LIFE
VA3349759OtherCIGNA
VA232426OtherMAMSI
VA43439OtherSENTARA
VA3349759OtherCIGNA
080008075Medicare ID - Type Unspecified