Provider Demographics
NPI:1740675982
Name:LAVENBURG, PHILIP (DO)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:LAVENBURG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY DRIVE C FL 4
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15240-1000
Mailing Address - Country:US
Mailing Address - Phone:412-360-6191
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY DRIVE C FL 4
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15240-1000
Practice Address - Country:US
Practice Address - Phone:412-360-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-04
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS021989207R00000X, 207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program