Provider Demographics
NPI:1578528709
Name:LAVETTER, ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:LAVETTER
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 1:20358 MILJEVICH DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4349
Mailing Address - Country:US
Mailing Address - Phone:408-284-2282
Mailing Address - Fax:408-754-0450
Practice Address - Street 1:20358 MILJEVICH DR
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4349
Practice Address - Country:US
Practice Address - Phone:408-284-2282
Practice Address - Fax:408-754-0450
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15571208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G155710Medicaid
CA00G155710Medicare PIN
CAA39568Medicare UPIN