Provider Demographics
NPI:1801005632
Name:LAMANTIA, MICHAEL ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:LAMANTIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:792 COLLEGE PKWY
Mailing Address - Street 2:UVM MEDICAL CENTER - DIV. OF INTERNAL MED. & GERIATRICS
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-3052
Mailing Address - Country:US
Mailing Address - Phone:802-847-1111
Mailing Address - Fax:802-847-7594
Practice Address - Street 1:792 COLLEGE PKWY
Practice Address - Street 2:UVM MEDICAL CENTER - DIV. OF INTERNAL MED. & GERIATRICS
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-3052
Practice Address - Country:US
Practice Address - Phone:802-847-1111
Practice Address - Fax:802-847-7594
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2016-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2008-00511207RG0300X
IN01069340A207RG0300X
VT042.0013352207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201025030Medicaid
INM400049617Medicare PIN
IN264430096Medicare PIN