MEDICARE: DR. WILLIAM J LAURETTI D.C.

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	111N00000X	Chiropractor	1469-PT	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	524355-02	OTHER	MD	CAREFIRST BC/BS MARYLAND
2	778111	OTHER		PHCS NETWORK
3	P 1579733	OTHER		FIRST HEALTH NETWORK
4	S973	OTHER	MD	CAREFIRST BC/BS NAT'L CAP
5	2100731	OTHER		MAMSI/UNITEDHEALTHCARE

General Provider Information

NPI Number	:	1801894589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM J LAURETTI D.C.

Provider Business Mailing Address
First Line	:	16220 S FREDERICK AVE
Second Line	:	SUITE 500
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-4039
Country	:	US
Telephone Number	:	301-258-8877
Fax Number	:	301-208-1188

Provider Business Practice Location Address
First Line	:	16220 S FREDERICK AVE
Second Line	:	SUITE 500
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-4039
Country	:	US
Telephone Number	:	301-258-8877
Fax Number	:	301-208-1188

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/09/2007

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Directions to “ DR. WILLIAM J LAURETTI D.C.” Practice Location

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