Provider Demographics
NPI:1568426732
Name:LAVIN, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:LAVIN
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 1:356 LODER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH WAVERLY
Mailing Address - State:PA
Mailing Address - Zip Code:18840-2611
Mailing Address - Country:US
Mailing Address - Phone:570-882-7414
Mailing Address - Fax:570-888-1204
Practice Address - Street 1:356 LODER ST
Practice Address - Street 2:
Practice Address - City:SOUTH WAVERLY
Practice Address - State:PA
Practice Address - Zip Code:18840-2611
Practice Address - Country:US
Practice Address - Phone:570-882-7414
Practice Address - Fax:570-888-1204
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072058L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001815370Medicaid
PA1439241OtherHIGHMARK BLUE SHIELD NUMB
PA001815370Medicaid
PAF97352Medicare UPIN