Provider Demographics
NPI:1336136761
Name:LAVALLEE, ERICK JP (MD)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:JP
Last Name:LAVALLEE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:44 MAIN ST
Mailing Address - Street 2:STE 200
Mailing Address - City:RICHFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05476-1141
Mailing Address - Country:CA
Mailing Address - Phone:802-255-5500
Mailing Address - Fax:802-255-5589
Practice Address - Street 1:44 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHFORD
Practice Address - State:VT
Practice Address - Zip Code:05476-1153
Practice Address - Country:US
Practice Address - Phone:802-255-5500
Practice Address - Fax:802-255-5509
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2018-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT042-0010825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010984Medicaid
VT00068325OtherBCBS
VTG31388Medicare UPIN
VT00068325OtherBCBS
VT1010984Medicaid