Healthcare Provider Details

I. General information

NPI: 1427013911
Provider Name (Legal Business Name): LAWRENCE COUNTY ORTHOPEDICS AND SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 WILMINGTON RD
NEW CASTLE PA
16105
US

IV. Provider business mailing address

3120 WILMINGTON RD
NEW CASTLE PA
16105
US

V. Phone/Fax

Practice location:
  • Phone: 724-658-5311
  • Fax: 724-658-6155
Mailing address:
  • Phone: 724-658-5311
  • Fax: 724-658-6155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: TIMOTHY S GRAHAM
Title or Position: PRESIDENT
Credential: MD
Phone: 724-658-5311