Basic Information
| Provider Information | |||||||||
| NPI: | 1184944191 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAWRENCE | ||||||||
| FirstName: | CAMELIA | ||||||||
| MiddleName: | ARLENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2660 MAIN ST STE 216 | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066065301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036963545 | ||||||||
| FaxNumber: | 2035816509 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 N MOUNTAIN RD STE 201 | ||||||||
| Address2: | |||||||||
| City: | PLAINVILLE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060621848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602245416 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2010 | ||||||||
| LastUpdateDate: | 04/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 54332 | CT | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 03350227 | 05 | NY | MEDICAID |