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Individual

DR. LAWRENCE VIDAVER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1414 CRAIN HWY N, STE 6A, GLEN BURNIE, MD 21061-7001
(410) 761-1031
(410) 761-1031
Mailing address
1414 CRAIN HWY N, STE 6A, GLEN BURNIE, MD 21061-7001
(410) 848-8202
(410) 848-2644

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
025559
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
400999100
MD
Enumeration date
05/12/2007
Last updated
05/17/2024
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