Provider Demographics
NPI:1538893722
Name:SANDRA LAWRENCE MD PA
Entity type:Organization
Organization Name:SANDRA LAWRENCE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-696-5623
Mailing Address - Street 1:PO BOX 970845
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33497-0845
Mailing Address - Country:US
Mailing Address - Phone:954-696-5623
Mailing Address - Fax:561-756-8969
Practice Address - Street 1:9960 CENTRAL PARK BLVD N STE 225
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1705
Practice Address - Country:US
Practice Address - Phone:954-696-5623
Practice Address - Fax:561-756-8969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric RheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255036900Medicaid