1457547655 NPI number — KEAN B. LAWLOR, MD, PLLC

Table of content: (NPI 1457547655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457547655 NPI number — KEAN B. LAWLOR, MD, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEAN B. LAWLOR, MD, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457547655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22833 BOTHELL EVERETT HWY
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
BOTHELL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98021-9385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-486-2340
Provider Business Mailing Address Fax Number:
425-483-8135

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21701 76TH AVE W
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
EDMONDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98026-7536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-525-1168
Provider Business Practice Location Address Fax Number:
206-525-1169
Provider Enumeration Date:
09/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HEUPEL
Authorized Official First Name:
BETTY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
425-486-2340

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  MD30728 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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