Healthcare Provider Details

I. General information

NPI: 1619951845
Provider Name (Legal Business Name): LAWRENCE W KRIEGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 W GENESEE ST MEDICAL CENTER WEST #215
CAMILLUS NY
13031-3200
US

IV. Provider business mailing address

5700 W GENESEE ST STE 229
CAMILLUS NY
13031-3200
US

V. Phone/Fax

Practice location:
  • Phone: 315-234-9865
  • Fax: 315-234-9858
Mailing address:
  • Phone: 315-234-9865
  • Fax: 315-234-9864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number180996-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: