Provider Demographics
NPI:1679515613
Name:LAWRENCE, MELANIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:LAWRENCE
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 1:5449 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05051-9773
Mailing Address - Country:US
Mailing Address - Phone:802-280-5885
Mailing Address - Fax:
Practice Address - Street 1:4628 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:VT
Practice Address - Zip Code:05051-4628
Practice Address - Country:US
Practice Address - Phone:802-866-3010
Practice Address - Fax:802-866-3012
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009948Medicaid
VTP00085304OtherRAIL ROAD MEDICARE
VTH92765Medicare PIN
NHNX4552Medicare PIN
VT1009948Medicaid
H92765Medicare UPIN
VTVN3252Medicare PIN