Provider Demographics
NPI:1619951845
Name:KRIEGER, LAWRENCE W (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:W
Last Name:KRIEGER
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 1:5700 W GENESEE ST
Mailing Address - Street 2:STE 229
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-3200
Mailing Address - Country:US
Mailing Address - Phone:315-234-9865
Mailing Address - Fax:315-234-9864
Practice Address - Street 1:5700 W GENESEE ST
Practice Address - Street 2:MEDICAL CENTER WEST #215
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-3200
Practice Address - Country:US
Practice Address - Phone:315-234-9865
Practice Address - Fax:315-234-9858
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180996-1207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF29078Medicare UPIN
NY55304DMedicare ID - Type Unspecified