Provider Demographics
NPI:1508845017
Name:MAMBRINO, LAWRENCE JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOHN
Last Name:MAMBRINO
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 1:300 MOUNT AUBURN ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5600
Mailing Address - Country:US
Mailing Address - Phone:617-354-1010
Mailing Address - Fax:617-354-7961
Practice Address - Street 1:300 MOUNT AUBURN ST
Practice Address - Street 2:SUITE 308
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5600
Practice Address - Country:US
Practice Address - Phone:617-354-1010
Practice Address - Fax:617-354-7961
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74021207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3091872Medicaid
MA3091872Medicaid
MAE85852Medicare UPIN