Provider Demographics
NPI:1558457911
Name:LEMONS, LORRAINE S (DO)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:S
Last Name:LEMONS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:6 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3791
Practice Address - Country:US
Practice Address - Phone:518-641-6319
Practice Address - Fax:518-641-6850
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220865208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY050207000049OtherFIDELIS
NY000498653002OtherBSNENY
NY02165951Medicaid
NY364825OtherMVP
NY200107OtherSENIOR WHOLE HEALTH
NY76906OtherGHI/HMO
NY10054284OtherCDPHP
NY582141OtherEMPIRE BC
NY7661249OtherAETNA
NY582141OtherEMPIRE BC
NY76906OtherGHI/HMO