MEDICARE: DR. LAWRENCE MATTHEW MINARDI

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	174400000X	Specialist	11596	WV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MI9220052	OTHER	WV	MEDICARE GROUP NUMBER

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	:	1174508774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE MATTHEW MINARDI

Provider Business Mailing Address
First Line	:	500 DONNALLY ST
Second Line	:	STE 1
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1600
Country	:	US
Telephone Number	:	304-343-0331
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 DONNALLY ST
Second Line	:	BLDG B NORTH
City	:	CHARLESTON
State	:	WV
Zip	:	25301-1648
Country	:	US
Telephone Number	:	304-343-6219
Fax Number	:	304-343-1423

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	10/27/2016

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Directions to “ DR. LAWRENCE MATTHEW MINARDI ” Practice Location

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