MEDICARE: LAWRENCE O'MALLEY PAC

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	363AS0400X	Surgical Physician Assistant	0520P	NH

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	:	1427038751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE O'MALLEY PAC

Provider Business Mailing Address
First Line	:	264 PLEASANT ST
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-2551
Country	:	US
Telephone Number	:	603-224-3368
Fax Number	:	603-224-7815

Provider Business Practice Location Address
First Line	:	264 PLEASANT ST
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-2551
Country	:	US
Telephone Number	:	603-224-3368
Fax Number	:	603-224-7815

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	01/29/2024

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Directions to “ LAWRENCE O'MALLEY PAC” Practice Location

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