Individual
LAWRENCE DIDOMENICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
8175 MARKET ST, BOARDMAN, OH 44512-6244
(330) 629-8800
(330) 758-4914
Mailing address
PO BOX 378, SANDUSKY, OH 44871-0378
(419) 626-6161
(419) 502-3511
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
236
WV
213E00000X
Podiatrist
Primary
36-00-2513
OH
213E00000X
Podiatrist
SC-00-3181
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01145989
—
PA
05
—
0712232
—
OH
01
—
1013181-1045507
WORKERS COMP
WV
01
—
4117771
AETNA
—
01
—
539836
HIGHMARK
—
05
—
6420012
—
WV
01
—
P02513
THE HEALTH PLAN
—
Enumeration date
07/07/2005
Last updated
02/21/2019
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