Healthcare Provider Details

I. General information

NPI: 1639170582
Provider Name (Legal Business Name): WILLIAM JOHN LAUER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 WILMINGTON RD SUITE 200
NEW CASTLE PA
16105-1537
US

IV. Provider business mailing address

2602 WILMINGTON RD SUITE 200
NEW CASTLE PA
16105-1537
US

V. Phone/Fax

Practice location:
  • Phone: 724-657-3204
  • Fax: 724-652-7144
Mailing address:
  • Phone: 724-657-3204
  • Fax: 724-652-7144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD060756L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: