MEDICARE: THOMAS A LAUDERMAN DO

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	1433	WV

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	:	1891713582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS A LAUDERMAN DO

Provider Business Mailing Address
First Line	:	255 SUNBRIDGE DR
Second Line	:
City	:	SALEM
State	:	WV
Zip	:	26426-8400
Country	:	US
Telephone Number	:	304-782-3000
Fax Number	:	304-782-3003

Provider Business Practice Location Address
First Line	:	255 SUNBRIDGE DR
Second Line	:
City	:	SALEM
State	:	WV
Zip	:	26426-8400
Country	:	US
Telephone Number	:	304-782-3000
Fax Number	:	304-782-3003

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	11/12/2013

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Directions to “ THOMAS A LAUDERMAN DO” Practice Location

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