Provider Demographics
NPI:1184944191
Name:LAWRENCE, CAMELIA ARLENE (MD)
Entity type:Individual
Prefix:DR
First Name:CAMELIA
Middle Name:ARLENE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2660 MAIN ST STE 216
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5301
Mailing Address - Country:US
Mailing Address - Phone:203-696-3545
Mailing Address - Fax:203-581-6509
Practice Address - Street 1:201 N MOUNTAIN RD STE 201
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1848
Practice Address - Country:US
Practice Address - Phone:860-224-5416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT54332208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03350227Medicaid
NYJ400059116Medicare PIN