Active NPI
Lawrence H Wilson, MD
- Family Medicine Physician
- Mentor, OH
National Provider Identifier
1700853439
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 35045873
- Practice address
- 9500 Mentor Ave
Suite 100
Mentor, OH 44060-8713 - Phone
- (440) 352-4880
- Fax
- (440) 352-3629
- NPI assigned
- Mar 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35045873 | OH | Primary |
Addresses
Primary practice location
9500 Mentor Ave
Suite 100
Mentor, OH 44060-8713
Mailing address
9500 Mentor Ave
Suite 100
Mentor, OH 44060-8713
Phone (440) 352-4880
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0471449 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421020800000",
"number": "1700853439",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9500 MENTOR AVE",
"address_2": "SUITE 100",
"city": "MENTOR",
"state": "OH",
"postal_code": "440608713",
"telephone_number": "440-352-4880",
"fax_number": "440-352-3629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9500 MENTOR AVE",
"address_2": "SUITE 100",
"city": "MENTOR",
"state": "OH",
"postal_code": "440608713",
"telephone_number": "440-352-4880",
"fax_number": "440-352-3629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "LAWRENCE",
"middle_name": "H",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-01",
"last_updated": "2015-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OH",
"license": "35045873",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0471449",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mentor, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.