Provider Demographics
NPI:1669792271
Name:MELAINE C LAWRENCE MD
Entity type:Organization
Organization Name:MELAINE C LAWRENCE MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELAINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-866-3000
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:NEWBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05051-0037
Mailing Address - Country:US
Mailing Address - Phone:802-866-3000
Mailing Address - Fax:802-866-3012
Practice Address - Street 1:4628 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEWBURY
Practice Address - State:VT
Practice Address - Zip Code:05051-9775
Practice Address - Country:US
Practice Address - Phone:802-866-3000
Practice Address - Fax:802-866-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT207Q00000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1017789Medicaid
NH30209633Medicaid