Provider Demographics
NPI:1558497602
Name:ALLEGRO-SKINNER, LORRAINE MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:MARY
Last Name:ALLEGRO-SKINNER
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 1:2044 NY-32
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MODENA
Mailing Address - State:NY
Mailing Address - Zip Code:12548
Mailing Address - Country:US
Mailing Address - Phone:845-883-5176
Mailing Address - Fax:
Practice Address - Street 1:2044 NY-32
Practice Address - Street 2:SUITE 4
Practice Address - City:MODENA
Practice Address - State:NY
Practice Address - Zip Code:12548
Practice Address - Country:US
Practice Address - Phone:845-883-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03136587Medicaid
NY03136587Medicaid
G78010Medicare UPIN