Provider Demographics
NPI:1871636167
Name:PALLADINO, LAWRENCE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MICHAEL
Last Name:PALLADINO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 MISSION BLVD
Mailing Address - Street 2:SUTTER AMADOR HOSPITAL
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2564
Mailing Address - Country:US
Mailing Address - Phone:209-295-5544
Mailing Address - Fax:209-295-5233
Practice Address - Street 1:24685 STATE HIGHWAY 88
Practice Address - Street 2:PIONEER HEALTH CENTER
Practice Address - City:PIONEER
Practice Address - State:CA
Practice Address - Zip Code:95666
Practice Address - Country:US
Practice Address - Phone:209-295-5544
Practice Address - Fax:209-295-5233
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG 62607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG 62607OtherMEDICAL LICENSE
B87276Medicare UPIN