Provider Demographics
NPI:1962449025
Name:KRING, LAWRENCE IVAN (MD)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:IVAN
Last Name:KRING
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 1:50 LEROY ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1786
Mailing Address - Country:US
Mailing Address - Phone:315-265-3300
Mailing Address - Fax:315-261-6025
Practice Address - Street 1:80 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1450
Practice Address - Country:US
Practice Address - Phone:315-261-5871
Practice Address - Fax:315-714-3068
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238150-1207R00000X
NY238105-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010238150OtherBLUE CROSS BLUE SH
NY1962449025OtherFIDELIS
238150OtherLICENSE
NY00041188601OtherBLUE SHIELD OF NENY
NY02753419Medicaid
NYP000000208907OtherGHI FHP
NYRB1409OtherPALMETTO GBA
NYRB1409Medicare PIN
RB8796Medicare PIN