Provider Demographics
NPI:1609144799
Name:LAVINE, STEVEN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:RICHARD
Last Name:LAVINE
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 1:271 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-2862
Mailing Address - Country:US
Mailing Address - Phone:415-383-2882
Mailing Address - Fax:415-383-2892
Practice Address - Street 1:271 MILLER AVE
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2862
Practice Address - Country:US
Practice Address - Phone:415-383-2882
Practice Address - Fax:415-383-2892
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31723174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG31723OtherCA STATE LICENSE #
CAG31723OtherCA STATE LICENSE #