Lawrence Vidaver MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

025559 Issued in MD

Legal business name

LAWRENCE VIDAVER MD

Practice address

1411 Madison Park Dr
Glen Burnie, MD 21061-5613

Phone

(410) 761-1037

Fax

(410) 298-8225

NPI assigned

May 12, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Louise Macy

Title

Billing MGR

Phone

(410) 298-8223

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195516800000",
    "number": "1336354356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2506 LARRYVALE RD",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093206",
            "telephone_number": "410-764-1116",
            "fax_number": "410-298-8225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 MADISON PARK DR",
            "city": "GLEN BURNIE",
            "state": "MD",
            "postal_code": "210615613",
            "telephone_number": "410-761-1037",
            "fax_number": "410-298-8225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAWRENCE VIDAVER MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-12",
        "last_updated": "2007-11-20",
        "status": "A",
        "authorized_official_last_name": "MACY",
        "authorized_official_first_name": "LOUISE",
        "authorized_official_title_or_position": "BILLING MGR",
        "authorized_official_telephone_number": "410-298-8223"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "025559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Kaye Larsen
• Jerome Cabalhin Lastimosa, CRNP-ADULT
• David Lauver, MD
• Veronica Garcia Lavind, LCSW-C
• Jerry Lawler, PHD
• Lawrence W. Adler MD PA
• Lawrence W. Adler, M.D., P.a.
• Laws Restoration of Hope
• Niokie Laws
• Ha T Le, M.D.

• Internal Medicine Physician in Glen Burnie, MD
• Providers in Glen Burnie, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.