Basic Information
| Provider Information | |||||||||
| NPI: | 1194179671 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAWRENCE | ||||||||
| FirstName: | CHRISTIAN | ||||||||
| MiddleName: | BLAKE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 MACNIDER BUILDING | ||||||||
| Address2: | CB 7220 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997220 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 260 MACNIDER BUILDING | ||||||||
| Address2: | CB 7220 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199661505 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2016 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 219029 | NC | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 2019-00372 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.