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General NPI Number Information
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NPI Number | 1174858138
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Entity Type | Individual
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Provider Name | LORENZO MANNELLI M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/08/2009
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | 1959 NE PACIFIC STREET BOX 357115
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City | SEATTLE
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State | WA
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Zip | 98195-7115
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Country | US
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Telephone | 646-226-5924
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Fax |
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Provider Business Mailing Address
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Address Line | 22 LLANFAIR RD UNIT 6
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City | ARDMORE
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State | PA
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Zip | 19003-2320
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Country | US
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Telephone | 107-856-3276
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25MA09938700
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License Number State | NJ
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