MEDICARE: NANCY BETH LARES MD

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	22263	WV
2	208M00000X	Hospitalist Physician	22263	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	550737600	OTHER	WV	TAX IDENTIFICATION

General Provider Information

NPI Number	:	1841227790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY BETH LARES MD

Provider Business Mailing Address
First Line	:	1400 HOSPITAL DR
Second Line	:
City	:	HURRICANE
State	:	WV
Zip	:	25526-9202
Country	:	US
Telephone Number	:	304-675-1484
Fax Number	:	304-675-1489

Provider Business Practice Location Address
First Line	:	2414 JEFFERSON AVE
Second Line	:
City	:	PT PLEASANT
State	:	WV
Zip	:	25550-1528
Country	:	US
Telephone Number	:	304-675-1484
Fax Number	:	304-675-1489

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	05/25/2017

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