Healthcare Provider Details

I. General information

NPI: 1316975873
Provider Name (Legal Business Name): LAWRENCE M MANION M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 02/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 CHURCH ST
CARTHAGE NY
13619-1212
US

IV. Provider business mailing address

7715 SAND POND RD
GLENFIELD NY
13343-2213
US

V. Phone/Fax

Practice location:
  • Phone: 315-493-0128
  • Fax: 315-493-6200
Mailing address:
  • Phone: 315-376-3553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number147069
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: