Provider Demographics
NPI:1497848154
Name:SCHMETTERER, LAWRENCE I (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:I
Last Name:SCHMETTERER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 BOARDMAN CANFIELD RD
Mailing Address - Street 2:STE 3
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4344
Mailing Address - Country:US
Mailing Address - Phone:330-743-3604
Mailing Address - Fax:
Practice Address - Street 1:20 OHLTOWN RD
Practice Address - Street 2:STE 204
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2331
Practice Address - Country:US
Practice Address - Phone:330-743-3604
Practice Address - Fax:330-743-6707
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 062877174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0879214Medicaid
OHSC070813Medicare ID - Type Unspecified
OHF15970Medicare UPIN