Basic Information
| Provider Information | |||||||||
| NPI: | 1932197803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 METRO CENTER BLVD STE 2000 | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028861785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014322520 | ||||||||
| FaxNumber: | 4014538220 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 METRO CENTER BLVD STE 2000 | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028861785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014322520 | ||||||||
| FaxNumber: | 4014538220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 03/18/2019 | ||||||||
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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 | 2085R0202X | 8653 | RI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD08653 | RI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 008653 | 01 | BLUESHIELD | OTHER | 1988 | 01 | NHPRI | OTHER | 007005846 | 01 | HOSPITALPIN | OTHER | 16-00203 | 01 | UNITEDHEALTHPLANS | OTHER | 720055401 | 01 | CIGNA | OTHER | 008653 | 01 | TUFTS | OTHER | 3200361 | 01 | MASSMEDICAID | OTHER | 7005839 | 01 | RIMEDICALASSISTANCE | OTHER | 241361 | 01 | RIHPILGRIM | OTHER | 300072587 | 01 | RAILROAD MEDICARE | OTHER | 3200361 | 01 | HEALTHYSTART | OTHER | 400990 | 01 | BLUECHIP | OTHER |