Provider Demographics
NPI:1770921991
Name:PANEBIANCO, LAUREN MIKESELL (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:MIKESELL
Last Name:PANEBIANCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:CATHLEEN
Other - Last Name:MIKESELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5008 BRITTONFIELD PKWY STE 700
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9249
Mailing Address - Country:US
Mailing Address - Phone:315-472-7504
Mailing Address - Fax:
Practice Address - Street 1:5008 BRITTONFIELD PKWY STE 700
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9249
Practice Address - Country:US
Practice Address - Phone:315-472-7504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284318207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
284318OtherLICENSE