Provider Demographics
NPI:1598759771
Name:POLETTI, LAWRENCE F (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:F
Last Name:POLETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2010 ATHERHOLT RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1106
Mailing Address - Country:US
Mailing Address - Phone:434-200-3901
Mailing Address - Fax:434-947-3907
Practice Address - Street 1:1911 THOMSON DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1008
Practice Address - Country:US
Practice Address - Phone:434-947-3901
Practice Address - Fax:434-947-3907
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052249174400000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1598759771Medicaid
VA1598759771Medicaid
VA020001506Medicare PIN