Provider Demographics
NPI:1457674947
Name:LAVELY, RICHARD ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:LAVELY
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 1:695 ORANGE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-1830
Mailing Address - Country:US
Mailing Address - Phone:203-795-4117
Mailing Address - Fax:
Practice Address - Street 1:695 ORANGE CENTER RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-1830
Practice Address - Country:US
Practice Address - Phone:203-795-4117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT19373207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU59159Medicare UPIN