Provider Demographics
NPI:1659309599
Name:LAWRENCE, DENISE ANTOINETTE (MD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:ANTOINETTE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MCCLELLAN ST
Mailing Address - Street 2:MSGR KEANE BLDG
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1009
Mailing Address - Country:US
Mailing Address - Phone:518-346-3222
Mailing Address - Fax:518-346-2436
Practice Address - Street 1:600 MCCLELLAN ST
Practice Address - Street 2:MSGR KEANE BLDG
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1009
Practice Address - Country:US
Practice Address - Phone:518-346-3222
Practice Address - Fax:518-346-2436
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186370207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY691751OtherEMPIRE BC
NY000401375001OtherBSNENY
NY01254008Medicaid
NY070126000017OtherFIDELIS
NY200110OtherSENIOR WHOLE HEALTH
NY47342OtherGHI/HMO
NY08182OtherMVP
NY10001144OtherCDPHP
NY5379070OtherAETNA
NYE94228Medicare UPIN
NY56823NMedicare ID - Type UnspecifiedUPSTATE MEDICARE