Provider Demographics
NPI:1720059843
Name:LAVERY, ERIC ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ALAN
Last Name:LAVERY
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 1:621 RIDGELY AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1083
Mailing Address - Country:US
Mailing Address - Phone:410-224-4887
Mailing Address - Fax:410-224-1428
Practice Address - Street 1:621 RIDGELY AVE STE 201
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1083
Practice Address - Country:US
Practice Address - Phone:410-224-4887
Practice Address - Fax:410-224-1428
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053525A207RG0100X
MDD89500207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN