Provider Demographics
NPI:1235227208
Name:LAVANDOSKY, GERALD JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:JAMES
Last Name:LAVANDOSKY
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1117 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009
Mailing Address - Country:US
Mailing Address - Phone:954-457-8771
Mailing Address - Fax:954-266-4006
Practice Address - Street 1:3501 JOHNSON ST
Practice Address - Street 2:DIVISION OF PEDIATRIC CRITICAL CARE
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5421
Practice Address - Country:US
Practice Address - Phone:954-265-6301
Practice Address - Fax:954-985-1434
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2022-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME707412080P0202X
FLME 00707412080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250679300Medicaid
FL250679300Medicaid
FLG13438Medicare UPIN