MEDICARE: LAURENCE ROGER PLUMB 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	207Q00000X	Family Medicine Physician	127734	NY

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	:	1770526097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURENCE ROGER PLUMB MD

Provider Business Mailing Address
First Line	:	5037 LAKE SHORE RD
Second Line	:
City	:	HAMBURG
State	:	NY
Zip	:	14075-5720
Country	:	US
Telephone Number	:	716-560-9995
Fax Number	:	866-253-5222

Provider Business Practice Location Address
First Line	:	5037 LAKE SHORE RD
Second Line	:
City	:	HAMBURG
State	:	NY
Zip	:	14075-5720
Country	:	US
Telephone Number	:	716-560-9995
Fax Number	:	866-253-5222

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	04/23/2014

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