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General NPI Number Information
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NPI Number | 1235351727
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Entity Type | Organization
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Legal Business Name | MAXIMO B. LOCKWARD, M.D., LLC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6714 MARKET ST SUITE 1
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City | BOARDMAN
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State | OH
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Zip | 44512-4500
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Country | US
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Telephone | 330-965-5850
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Fax |
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Provider Business Mailing Address
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Address Line | 6714 MARKET ST SUITE 1
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City | BOARDMAN
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State | OH
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Zip | 44512-4500
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Country | US
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Telephone | 330-965-5850
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAXIMO B LOCKWARD
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Credential | M.D.
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Telephone | 330-965-5850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35071065
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License Number State | OH
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