Provider Demographics
NPI:1225110109
Name:LAVIN, VIVIANA A (MD)
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:A
Last Name:LAVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:VIVIANA
Other - Last Name:ALVARADO-LAVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:222 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1870
Mailing Address - Country:US
Mailing Address - Phone:629-255-3486
Mailing Address - Fax:629-255-3075
Practice Address - Street 1:3901 CENTRAL PIKE STE 251
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3421
Practice Address - Country:US
Practice Address - Phone:629-255-2030
Practice Address - Fax:629-255-4221
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN040067208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5441140Medicaid
TN3333183Medicaid
TN5441140Medicaid