Healthcare Provider Details

I. General information

NPI: 1801981402
Provider Name (Legal Business Name): CHRISTINE VIVIAN LORENZO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

953 DANBY ROAD HAMMOND HEALTH CENTER - ITHACA COLLEGE
ITHACA NY
14850
US

IV. Provider business mailing address

217 CORNELL STREET
ITHACA NY
14850
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-3177
  • Fax:
Mailing address:
  • Phone: 607-274-3177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number183553
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: