Provider Demographics
NPI:1467498840
Name:REYES, LAVINIA T (MD)
Entity Type:Individual
Prefix:DR
First Name:LAVINIA
Middle Name:T
Last Name:REYES
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:12200 PAWLEYS MILL CIR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-7976
Mailing Address - Country:US
Mailing Address - Phone:919-435-6111
Mailing Address - Fax:919-435-6113
Practice Address - Street 1:11081 FOREST PINES DR
Practice Address - Street 2:SUITE 124
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7655
Practice Address - Country:US
Practice Address - Phone:919-435-6111
Practice Address - Fax:919-435-6113
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2021-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9701126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910888Medicaid
G62957Medicare UPIN
NC8910888Medicaid