Provider Demographics
NPI:1609371129
Name:LAWRENCE, SAMUEL PHILLIPS (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:PHILLIPS
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 14TH ST NW APT 914
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4151
Mailing Address - Country:US
Mailing Address - Phone:202-365-6814
Mailing Address - Fax:
Practice Address - Street 1:3800 RESERVOIR RD NW DEPT OF ANESTHESIA
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-8640
Practice Address - Fax:202-444-8854
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD0093714207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program