Individual
LAWRENCE JOHN FANELLY JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2600 NAVARRE AVE, OREGON, OH 43616-3207
(419) 696-7216
(419) 696-2123
Mailing address
P.O. BOX 1188, BOWLING GREEN, OH 43402-1188
(419) 698-9711
(419) 698-2841
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
34003344F
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0494924
—
OH
05
—
3402510110
—
MI
Enumeration date
01/20/2006
Last updated
09/15/2017
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