Provider Demographics
NPI:1144291147
Name:ALWINE, LAWRENCE K (D O)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:K
Last Name:ALWINE
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BALDERSTON DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2004
Mailing Address - Country:US
Mailing Address - Phone:610-363-8598
Mailing Address - Fax:
Practice Address - Street 1:77 MANOR AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-2620
Practice Address - Country:US
Practice Address - Phone:610-269-9570
Practice Address - Fax:610-269-3568
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003509L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006877940003Medicaid
PA0006877940003Medicaid