MEDICARE: LAWRENCE M MINARDI

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	332H00000X	Eyewear Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336216498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE M MINARDI

Provider Business Mailing Address
First Line	:	500 DONNALLY ST
Second Line	:	SUITE 101
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1648
Country	:	US
Telephone Number	:	304-346-0292
Fax Number	:	304-343-1423

Provider Business Practice Location Address
First Line	:	500 DONNALLY ST
Second Line	:	SUITE 101
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1648
Country	:	US
Telephone Number	:	304-346-0292
Fax Number	:	304-343-1423

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LAWRENCE MATTHEW MINARDI
Credential	:	MD
Telephone Number	:	304-343-6219

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	10/02/2008

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Directions to “LAWRENCE M MINARDI ” Practice Location

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