Provider Demographics
NPI:1073509568
Name:LAVIGNE, JAY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:WAYNE
Last Name:LAVIGNE
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 1:277 WHITE ST NE
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2913
Mailing Address - Country:US
Mailing Address - Phone:276-628-4335
Mailing Address - Fax:276-628-3195
Practice Address - Street 1:277 WHITE ST NE
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2913
Practice Address - Country:US
Practice Address - Phone:276-628-4335
Practice Address - Fax:276-628-3195
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043601207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010380855Medicaid
VA1073509568Medicaid
SDQ023274Medicaid
VAB18030Medicare UPIN
VAVVJ947BMedicare PIN
VA160000496Medicare PIN