Provider Demographics
NPI:1023043114
Name:CHIN, LAWRENCE S (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:S
Last Name:CHIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 IRVING AVE
Mailing Address - Street 2:STE. 503
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1603
Mailing Address - Country:US
Mailing Address - Phone:315-464-4470
Mailing Address - Fax:315-464-5520
Practice Address - Street 1:725 IRVING AVE
Practice Address - Street 2:STE. 503
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1603
Practice Address - Country:US
Practice Address - Phone:315-464-4470
Practice Address - Fax:315-464-5520
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228001207T00000X
NY261941207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03374765Medicaid
NYJ400051492Medicare PIN