Provider Demographics
NPI:1710272323
Name:HAIRSTON, LAVONNE (MD)
Entity Type:Individual
Prefix:
First Name:LAVONNE
Middle Name:
Last Name:HAIRSTON
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 1:3108 SHARPIE CT
Mailing Address - Street 2:
Mailing Address - City:VA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-3454
Mailing Address - Country:US
Mailing Address - Phone:757-322-0608
Mailing Address - Fax:
Practice Address - Street 1:6400 ARLINGTON BLVD STE 210
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-2349
Practice Address - Country:US
Practice Address - Phone:703-531-3000
Practice Address - Fax:703-531-3142
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101258295174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAINTERNMedicaid
VA1710272323Medicaid
VAVVI010AMedicare UPIN