Eileen M Lawrence, M.D.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

036800 Issued in CT

Practice address

162 E Main St
Clinton, CT 06413-2116

Phone

(860) 669-7272

Fax

(860) 669-3337

NPI assigned

Jan 19, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: eileen.lawrence.npi1427038181.phpct@direct.optumcare.masshiway.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Prohealth Physicians PC

  • Family Medicine Physician
  • Farmington, CT
  • NPI 1720194053
  Medicare reassignment NPD
• Shoreline Pediatrics & Adolescent Medicine, P.C.

  • Pediatric Adolescent Medicine Physician
  • Madison, CT
  • NPI 1538126941
  NPD (past)

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427038181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "162 E MAIN ST",
            "city": "CLINTON",
            "state": "CT",
            "postal_code": "064132116",
            "telephone_number": "860-669-7272",
            "fax_number": "860-669-3337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "162 E MAIN ST",
            "city": "CLINTON",
            "state": "CT",
            "postal_code": "064132116",
            "telephone_number": "860-669-7272",
            "fax_number": "860-669-3337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWRENCE",
        "first_name": "EILEEN",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CT",
            "license": "036800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001368001",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lattana Tina Kettavong, PHARMD
• Kevin O'Connell DDS LLC
• Nadin Khalifa
• Amanda King, BCBA
• Michael L'Italien, PHARM.D.
• Tracey Jean Leary, RPH
• Lauren Mary Leo, RPH
• Adrienne Berge Loth, APRN
• Matthew Mancini, RN
• Mohammad Mahmoud Mansour, PHARMD.

• Pediatric Adolescent Medicine Physician in Clinton, CT
• Providers in Clinton, CT by specialty
• Pediatric Adolescent Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.