MEDICARE: LAWRENCE DOPERAK LP

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	103T00000X	Psychologist	PS-002459-L	PA

General Provider Information

NPI Number	:	1982884227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE DOPERAK LP

Provider Business Mailing Address
First Line	:	4150 WASHINGTON RD
Second Line	:	P.O. BOX 945
City	:	MC MURRAY
State	:	PA
Zip	:	15317-2534
Country	:	US
Telephone Number	:	724-941-1120
Fax Number	:	724-941-0993

Provider Business Practice Location Address
First Line	:	4150 WASHINGTON RD
Second Line	:	SUITE 105
City	:	MC MURRAY
State	:	PA
Zip	:	15317-2534
Country	:	US
Telephone Number	:	724-941-1120
Fax Number	:	724-941-0993

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

Provider Enumeration Date	:	11/04/2007
Last Update Date	:	11/04/2007

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