Provider Demographics
NPI:1417963166
Name:PARDEE, LAWRENCE A III (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:A
Last Name:PARDEE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:L.
Other - Middle Name:ALLEN
Other - Last Name:PARDEE
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:199 PARRISH ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1788
Mailing Address - Country:US
Mailing Address - Phone:585-394-6811
Mailing Address - Fax:585-394-7497
Practice Address - Street 1:199 PARRISH ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1788
Practice Address - Country:US
Practice Address - Phone:585-394-6811
Practice Address - Fax:585-394-7497
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2229092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I20348Medicare UPIN