Provider Demographics
NPI:1023125598
Name:LAMANA, SAMUEL (PA)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:LAMANA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 MAIN ST
Mailing Address - Street 2:WATKINS CENTRE
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6059
Mailing Address - Country:US
Mailing Address - Phone:860-527-5803
Mailing Address - Fax:860-524-0645
Practice Address - Street 1:935 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-6059
Practice Address - Country:US
Practice Address - Phone:860-527-5803
Practice Address - Fax:860-525-3687
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000668363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical