Basic Information
| Provider Information | |||||||||
| NPI: | 1316925142 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEUBER | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 BEECH DRIVE | ||||||||
| Address2: | |||||||||
| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102796100 | ||||||||
| FaxNumber: | 6102790670 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 BEECH DR | ||||||||
| Address2: | |||||||||
| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194035421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102796100 | ||||||||
| FaxNumber: | 6102790670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2006 | ||||||||
| LastUpdateDate: | 12/23/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | OA000499L | PA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | MA003514L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | C50000327 | DE | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1000033361 | 05 | DE | MEDICAID |