Provider Demographics
NPI:1083719330
Name:ANDRES B LAO JR MD
Entity Type:Organization
Organization Name:ANDRES B LAO JR MD
Other - Org Name:ANDRES B LAO JR MD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:330-821-8844
Mailing Address - Street 1:PO BOX 80690
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708
Mailing Address - Country:US
Mailing Address - Phone:330-833-5530
Mailing Address - Fax:330-833-6085
Practice Address - Street 1:75 GLAMORGAN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-2938
Practice Address - Country:US
Practice Address - Phone:330-821-8844
Practice Address - Fax:330-829-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAN9360781Medicare PIN