Provider Demographics
NPI:1730107632
Name:MAROLA, LEWIS J (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:J
Last Name:MAROLA
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 1:700 MCCLELLAN ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1019
Mailing Address - Country:US
Mailing Address - Phone:518-374-9153
Mailing Address - Fax:518-370-5195
Practice Address - Street 1:700 MCCLELLAN ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1019
Practice Address - Country:US
Practice Address - Phone:518-374-9153
Practice Address - Fax:518-370-5195
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091256207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00530043Medicaid
NY00530043Medicaid
B80727Medicare UPIN