Provider Demographics
NPI:1205865532
Name:LAMAR-BELLAMY, LAWANDA E (MD)
Entity Type:Individual
Prefix:
First Name:LAWANDA
Middle Name:E
Last Name:LAMAR-BELLAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 CROWLEY RAYNE HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-8210
Mailing Address - Country:US
Mailing Address - Phone:716-839-6720
Mailing Address - Fax:716-839-6740
Practice Address - Street 1:1307 CROWLEY RAYNE HWY
Practice Address - Street 2:SUITE B
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-8210
Practice Address - Country:US
Practice Address - Phone:716-839-6720
Practice Address - Fax:716-839-6740
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD205165208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
080627000062OtherFIDELIS
000528626005OtherBC/BS
NY02772530Medicaid
1205865532OtherUNIVERA
080627000064OtherFIDELIS
1213454OtherIHA
NY02772530Medicaid