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General NPI Number Information
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NPI Number | 1316975873
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Entity Type | Individual
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Provider Name | LAWRENCE M MANION M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 214 CHURCH ST
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City | CARTHAGE
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State | NY
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Zip | 13619-1212
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Country | US
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Telephone | 315-493-0128
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Fax | 315-493-6200
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Provider Business Mailing Address
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Address Line | 7715 SAND POND RD
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City | GLENFIELD
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State | NY
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Zip | 13343-2213
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Country | US
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Telephone | 315-376-3553
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 147069
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License Number State | NY
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