Provider Demographics
NPI:1720018070
Name:LAVERY, MARY ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:LAVERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:27059 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4064
Mailing Address - Country:US
Mailing Address - Phone:440-871-8933
Mailing Address - Fax:440-899-9462
Practice Address - Street 1:27059 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4064
Practice Address - Country:US
Practice Address - Phone:440-871-8933
Practice Address - Fax:440-899-9462
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-1201207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08-01054OtherUNITED HEALTHCARE
ID000000374414OtherUNICARE
OH53491OtherQUALCHOICE
OH800519742052OtherCARESOURCE
OH000000656327OtherANTHEM BLUE CROSS
OH3053574Medicaid
OH5683020001OtherD M E R C/MEDICARE
OH08-01054OtherUNITED HEALTHCARE
OH5683020001OtherD M E R C/MEDICARE