Provider Demographics
NPI:1801385760
Name:LARAVIE, GREGORY A
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:LARAVIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 W 1ST ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-1243
Mailing Address - Country:US
Mailing Address - Phone:937-293-1945
Mailing Address - Fax:937-293-8150
Practice Address - Street 1:33 W 1ST ST STE 100
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1243
Practice Address - Country:US
Practice Address - Phone:937-293-1945
Practice Address - Fax:937-293-8150
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator