Provider Demographics
NPI:1174858138
Name:MANNELLI, LORENZO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:LORENZO
Middle Name:
Last Name:MANNELLI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LLANFAIR RD UNIT 6
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2320
Mailing Address - Country:US
Mailing Address - Phone:107-856-3276
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC STREET
Practice Address - Street 2:BOX 357115
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-7115
Practice Address - Country:US
Practice Address - Phone:646-226-5924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA099387002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology