Provider Demographics
NPI:1568499176
Name:LORENZ, ALAN D (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:D
Last Name:LORENZ
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 1:117 LOMB MEMORIAL DR BLDG 23A
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-5608
Mailing Address - Country:US
Mailing Address - Phone:585-475-2555
Mailing Address - Fax:
Practice Address - Street 1:117 LOMB MEMORIAL DR BLDG 23A
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-5608
Practice Address - Country:US
Practice Address - Phone:585-475-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177849207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01307097Medicaid
NYJ400042284Medicare PIN
NYCC5331Medicare PIN
NY01307097Medicaid