Provider Demographics
NPI:1306833025
Name:LAMANNA, SUZANNE M (DO)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:LAMANNA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 N MAIN ST
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:N SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1644
Mailing Address - Country:US
Mailing Address - Phone:315-458-4623
Mailing Address - Fax:315-458-4652
Practice Address - Street 1:792 N MAIN ST
Practice Address - Street 2:SUITE 100B
Practice Address - City:N SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-1644
Practice Address - Country:US
Practice Address - Phone:315-458-4623
Practice Address - Fax:315-458-4652
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202002-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01682306Medicaid
NY01682306Medicaid
AA1119Medicare ID - Type Unspecified