Provider Demographics
NPI:1750439956
Name:PETER E. LAVINE, M.D.
Entity type:Organization
Organization Name:PETER E. LAVINE, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-223-8600
Mailing Address - Street 1:1145 19TH ST NW
Mailing Address - Street 2:SUITE 710
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-3701
Mailing Address - Country:US
Mailing Address - Phone:202-223-8600
Mailing Address - Fax:202-828-9376
Practice Address - Street 1:1145 19TH ST NW
Practice Address - Street 2:SUITE 710
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3701
Practice Address - Country:US
Practice Address - Phone:202-223-8600
Practice Address - Fax:202-828-9376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD18740302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
F12160Medicare UPIN