Provider Demographics
NPI:1073177846
Name:DEBELLIS, LAWRENCE PAUL-ANTHONY (DO, MS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:PAUL-ANTHONY
Last Name:DEBELLIS
Suffix:
Gender:M
Credentials:DO, MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:36 OLD KINGS HWY S STE 200
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4523
Mailing Address - Country:US
Mailing Address - Phone:203-852-2270
Mailing Address - Fax:
Practice Address - Street 1:36 OLD KINGS HWY S STE 200
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4523
Practice Address - Country:US
Practice Address - Phone:203-852-2270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-27
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT80635207RB0002X, 207RE0101X
SCMDO.89993LL207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLKPPJMOtherBCBS
FL114762600Medicaid