Provider Demographics
NPI:1801014055
Name:LAVU, HARISH (MD)
Entity Type:Individual
Prefix:DR
First Name:HARISH
Middle Name:
Last Name:LAVU
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 1:615 CHESTNUT ST
Mailing Address - Street 2:14TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 CHESTNUT ST
Practice Address - Street 2:14TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4404
Practice Address - Country:US
Practice Address - Phone:215-955-2141
Practice Address - Fax:215-955-2420
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063375A174400000X
PAMD434568208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022130930001Medicaid
NJ0175293Medicaid
PA1022130930001Medicaid