Provider Demographics
NPI:1669407573
Name:HARVATINE, LAURA LYNN (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:LYNN
Last Name:HARVATINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:703-369-8464
Mailing Address - Fax:703-369-8467
Practice Address - Street 1:8680 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4287
Practice Address - Country:US
Practice Address - Phone:703-369-8464
Practice Address - Fax:703-369-8467
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012486742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1669407573Medicaid
VA1669407573Medicaid
VAVV1420AMedicare PIN