MEDICARE: MS. DAWN DIANE WARD LMT

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	010397	NY

General Provider Information

NPI Number	:	1417159716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAWN DIANE WARD LMT

Provider Business Mailing Address
First Line	:	PO BOX 872
Second Line	:
City	:	SHOREHAM
State	:	NY
Zip	:	11786-0872
Country	:	US
Telephone Number	:	631-375-8828
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 MILLER AVE
Second Line	:
City	:	SHOREHAM
State	:	NY
Zip	:	11786-1803
Country	:	US
Telephone Number	:	631-375-8828
Fax Number	:

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	07/08/2007

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