Provider Demographics
NPI:1871276311
Name:LAMON, MACKENZIE (PA-C)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:LAMON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1252
Mailing Address - Country:US
Mailing Address - Phone:315-493-4187
Mailing Address - Fax:315-493-7227
Practice Address - Street 1:117 N MECHANIC ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1252
Practice Address - Country:US
Practice Address - Phone:315-493-4187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030445363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant