MEDICARE: THEODORE FRIED BURFORD WELCH & DAVID HAUER MD, PC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1639233901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THEODORE FRIED BURFORD WELCH & DAVID HAUER MD, PC

Provider Business Mailing Address
First Line	:	388 HAWKINS AVE
Second Line	:	SUITE 1
City	:	LAKE RONKONKOMA
State	:	NY
Zip	:	11779-4280
Country	:	US
Telephone Number	:	631-588-8460
Fax Number	:	631-588-8480

Provider Business Practice Location Address
First Line	:	388 HAWKINS AVE
Second Line	:	SUITE 1
City	:	LAKE RONKONKOMA
State	:	NY
Zip	:	11779-4280
Country	:	US
Telephone Number	:	631-588-8460
Fax Number	:	631-588-8480

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID HAUER
Credential	:	M.D.
Telephone Number	:	631-588-8460

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	12/07/2009

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