MEDICARE: DR. LAWRENCE M WELLS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	106532	NY

General Provider Information

NPI Number	:	1316920846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE M WELLS MD

Provider Business Mailing Address
First Line	:	20917 UNION TPKE
Second Line	:
City	:	HOLLIS HILLS
State	:	NY
Zip	:	11364-3237
Country	:	US
Telephone Number	:	718-464-2626
Fax Number	:	718-464-2641

Provider Business Practice Location Address
First Line	:	20917 UNION TURNPIKE
Second Line	:
City	:	HOLLIS HILLS
State	:	NY
Zip	:	11364
Country	:	US
Telephone Number	:	718-464-2626
Fax Number	:	718-464-2641

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	07/18/2008

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