Provider Demographics
NPI:1891788709
Name:MENSAH, LAVERNE G (MD)
Entity Type:Individual
Prefix:DR
First Name:LAVERNE
Middle Name:G
Last Name:MENSAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAVERNE
Other - Middle Name:E
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3100 PLAZA PROPERTIES BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1530
Mailing Address - Country:US
Mailing Address - Phone:614-383-6000
Mailing Address - Fax:614-383-6229
Practice Address - Street 1:3100 PLAZA PROPERTIES BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1530
Practice Address - Country:US
Practice Address - Phone:614-383-6000
Practice Address - Fax:614-383-6229
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08608900207VG0400X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0222437Medicaid
FLF07107Medicare UPIN