Individual provider Active NPI

Lawrence John Mambrino, MD

  • Otolaryngology Physician
  • Cambridge, MA
National Provider Identifier
1508845017
Registry record updated Jul 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
74021 Issued in MA
Practice address
300 Mount Auburn St
Suite 308
Cambridge, MA 02138-5600
Phone
(617) 354-1010
Fax
(617) 354-7961
NPI assigned
Jan 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 22, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X 74021 MA Primary

Addresses

Primary practice location

300 Mount Auburn St
Suite 308
Cambridge, MA 02138-5600

Mailing address

300 Mount Auburn St
Suite 308
Cambridge, MA 02138-5600
Phone (617) 354-1010

Other identifiers 1

IdentifierTypeStateIssuer
3091872MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050103000525 MA Practitioner - Otolaryngology 3476511700 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Tufts University School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cambridge OtolaryngologyGroup PAC ID 6406956853, 5 clinicians

Practice addresses (Care Compare)

300 Mount Auburn St
Suite 308
Cambridge, MA 02138-5665
Phone (617) 354-1010

Hospital & facility affiliations

  • Mount Auburn Hospital Hospital, Cambridge, MA, CCN 220002

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
74021MAMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Massachusetts Institute of Technology CurrentSince May 1, 1991 Accepting new patients
Cambridge Otolaryngology Otolaryngology CurrentSince Feb 14, 2006 Accepting new patients

Locations

25 Carleton St
Cambridge, MA 02142
Phone (617) 253-0556

300 Mount Auburn St
Ste 308
Cambridge, MA 02138
Phone (617) 354-1010

Interoperability endpoints

  • Direct secure messaging: lmambrino254069@direct.bilh.masshiway.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279756800000",
    "number": "1508845017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 MOUNT AUBURN ST",
            "address_2": "SUITE 308",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021385600",
            "telephone_number": "617-354-1010",
            "fax_number": "617-354-7961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MOUNT AUBURN ST",
            "address_2": "SUITE 308",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021385600",
            "telephone_number": "617-354-1010",
            "fax_number": "617-354-7961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMBRINO",
        "first_name": "LAWRENCE",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-12",
        "last_updated": "2010-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MA",
            "license": "74021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3091872",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cambridge, MA

Sources for this page

Verify at the official NPI Registry.