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1730164492

NPI Code Detail

MEDICARE: ISAGANI D LAURENCIO M.D.

MEDICARE: ISAGANI D LAURENCIO M.D.

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	208D00000X	General Practice Physician	D19954	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LU39HU 416653 02	OTHER	MD	CAREFIRST BC BS - HT.CLUB
2	41665301	OTHER	MD	CAREFIRST BC BS
3	E458 0015	OTHER	DC	BLUE CHOICE - HT. CLUB
4	K029 0003	OTHER	DC	BLUE CHOICE DC
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730164492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAGANI D LAURENCIO M.D.

Provider Business Mailing Address
First Line	:	408 KEAN TER
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-3322
Country	:	US
Telephone Number	:	301-759-2787
Fax Number	:

Provider Business Practice Location Address
First Line	:	10701 NEW GEORGES CREEK RD SW
Second Line	:
City	:	FROSTBURG
State	:	MD
Zip	:	21532-1457
Country	:	US
Telephone Number	:	301-689-3229
Fax Number	:	301-689-1129

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	09/11/2007

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1194858266 — SUSAN M MCMULLEN CRNP
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Directions to “ ISAGANI D LAURENCIO M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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