MEDICARE: LAWRENCE M WYNER 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	208800000X	Urology Physician	35059870	OH
2	208800000X	Urology Physician	16680	WV

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	:	1790843316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE M WYNER MD

Provider Business Mailing Address
First Line	:	1115 20TH STREET
Second Line	:	SUITE 107
City	:	HUNTINGTON
State	:	WV
Zip	:	25703
Country	:	US
Telephone Number	:	304-691-1900
Fax Number	:	304-691-1929

Provider Business Practice Location Address
First Line	:	1115 20TH ST
Second Line	:	SUITE 107
City	:	HUNTINGTON
State	:	WV
Zip	:	25703-2071
Country	:	US
Telephone Number	:	304-691-1900
Fax Number	:	304-691-1929

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	11/18/2021

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Directions to “ LAWRENCE M WYNER MD” Practice Location

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