Provider Demographics
NPI:1477641264
Name:LAVI, NIMROD (MD)
Entity Type:Individual
Prefix:DR
First Name:NIMROD
Middle Name:
Last Name:LAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NIMROD
Other - Middle Name:
Other - Last Name:SHICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:330 ORCHARD ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4429
Mailing Address - Country:US
Mailing Address - Phone:203-867-5400
Mailing Address - Fax:203-867-5401
Practice Address - Street 1:330 ORCHARD ST.
Practice Address - Street 2:SUITE 210
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4429
Practice Address - Country:US
Practice Address - Phone:203-867-5400
Practice Address - Fax:203-867-5401
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047574207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400003485Medicare PIN