MEDICARE: LAWRENCE I. IWUAMADI

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	332B00000X	Durable Medical Equipment & Medical Supplies	109520-0000-5200	VA

General Provider Information

NPI Number	:	1508871955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE I. IWUAMADI

Provider Business Mailing Address
First Line	:	3809 PRINCESS ANNE RD
Second Line	:	SUITE 108
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-1900
Country	:	US
Telephone Number	:	757-470-5661
Fax Number	:	757-470-5662

Provider Business Practice Location Address
First Line	:	3809 PRINCESS ANNE RD
Second Line	:	SUITE 108
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-1900
Country	:	US
Telephone Number	:	757-470-5661
Fax Number	:	757-470-5662

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MRS. CHINYERE A. IWUAMADI
Credential	:
Telephone Number	:	757-343-7569

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	11/24/2008

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