Provider Demographics
NPI:1477809184
Name:C WILLIAM LAVIN MD,LLC
Entity Type:Organization
Organization Name:C WILLIAM LAVIN MD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-872-9564
Mailing Address - Street 1:32 COLLEGE AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6100
Mailing Address - Country:US
Mailing Address - Phone:207-872-9564
Mailing Address - Fax:207-861-5458
Practice Address - Street 1:32 COLLEGE AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6100
Practice Address - Country:US
Practice Address - Phone:207-872-9564
Practice Address - Fax:207-861-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE40345Medicare UPIN