Provider Demographics
NPI:1659554111
Name:BOJJA, LAVANYA (MD)
Entity Type:Individual
Prefix:DR
First Name:LAVANYA
Middle Name:
Last Name:BOJJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2716
Mailing Address - Country:US
Mailing Address - Phone:315-425-4400
Mailing Address - Fax:315-425-4827
Practice Address - Street 1:800 IRVING AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2716
Practice Address - Country:US
Practice Address - Phone:315-425-4400
Practice Address - Fax:315-425-4827
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102367071Medicaid
MD956416OtherCAREFIRST MD BCBS
PA20096568OtherAMERIHEALTH MERCY-WMG
PAP009414OtherGATEWAY-WMG
PA283547OtherUNISON-WMG
PA2125431OtherHIGHMARK BLUE SHIELD-WMG
PAP009414OtherGATEWAY-WMG
PA20096568OtherAMERIHEALTH MERCY-WMG