Provider Demographics
NPI:1770599599
Name:LAVELLE, THOMAS FRANCIS JR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:FRANCIS
Last Name:LAVELLE
Suffix:JR
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 1:16253 CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4889
Mailing Address - Country:US
Mailing Address - Phone:574-273-3809
Mailing Address - Fax:
Practice Address - Street 1:16253 CYPRESS CT
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-4889
Practice Address - Country:US
Practice Address - Phone:574-273-3809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01022236A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
INE05819Medicare UPIN
IN737540Medicare ID - Type Unspecified