MEDICARE: LAWRENCE COUNTY ORTHOPEDICS AND SPORTS MEDICINE

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician		PA

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	:	1427013911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE COUNTY ORTHOPEDICS AND SPORTS MEDICINE

Provider Business Mailing Address
First Line	:	3120 WILMINGTON RD
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16105
Country	:	US
Telephone Number	:	724-658-5311
Fax Number	:	724-658-6155

Provider Business Practice Location Address
First Line	:	3120 WILMINGTON RD
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16105
Country	:	US
Telephone Number	:	724-658-5311
Fax Number	:	724-658-6155

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TIMOTHY S GRAHAM
Credential	:	MD
Telephone Number	:	724-658-5311

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	09/03/2008

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Directions to “LAWRENCE COUNTY ORTHOPEDICS AND SPORTS MEDICINE ” Practice Location

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