Provider Demographics
NPI:1700052792
Name:LAVIGNE, KERRY ALLISON (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:ALLISON
Last Name:LAVIGNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:ALLISON
Other - Last Name:SHARPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:195 UNION ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-6107
Mailing Address - Country:US
Mailing Address - Phone:207-706-5030
Mailing Address - Fax:877-343-6641
Practice Address - Street 1:195 UNION ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-6107
Practice Address - Country:US
Practice Address - Phone:207-706-5030
Practice Address - Fax:877-343-6641
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
390200000X
MEMD19615207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1215440011Medicaid