Provider Demographics
NPI:1821405366
Name:LAVERTY, ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:LAVERTY
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:323 LOWELL ST
Mailing Address - Street 2:ANDOVER MEDICAL CENTER & EXPRESSCARE
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-4501
Mailing Address - Country:US
Mailing Address - Phone:978-783-5000
Mailing Address - Fax:978-313-8188
Practice Address - Street 1:1 ELLIOT WAY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3599
Practice Address - Country:US
Practice Address - Phone:603-663-2534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MAPA5061363A00000X
NH1155363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant