Provider Demographics
NPI:1326048638
Name:LAVIN, MARC IRVING (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:IRVING
Last Name:LAVIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7345 MEDICAL CENTER DR STE 160
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1952
Mailing Address - Country:US
Mailing Address - Phone:818-676-4805
Mailing Address - Fax:818-676-4820
Practice Address - Street 1:7345 MEDICAL CENTER DR STE 160
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1952
Practice Address - Country:US
Practice Address - Phone:818-676-4805
Practice Address - Fax:818-676-4820
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2019-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA54809207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA54809OtherSTATE LICENSE
CA00A548090Medicaid
CAG72310Medicare UPIN