Provider Demographics
NPI:1528188836
Name:LAFAVER, KATHRIN (MD)
Entity Type:Individual
Prefix:
First Name:KATHRIN
Middle Name:
Last Name:LAFAVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRIN
Other - Middle Name:
Other - Last Name:CZARNECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6 CARE LN
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-8651
Mailing Address - Country:US
Mailing Address - Phone:518-693-4629
Mailing Address - Fax:
Practice Address - Street 1:6 CARE LN
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-8651
Practice Address - Country:US
Practice Address - Phone:518-693-4629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY462452084N0400X
IL036-1499022084N0400X
MA2433602084N0400X
NY3099252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201182190Medicaid
KY7100249200Medicaid
MNP00648817OtherRAILROAD MEDICARE