Provider Demographics
NPI:1801863469
Name:LAVINE, STEVEN JAY (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JAY
Last Name:LAVINE
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:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-6674
Mailing Address - Fax:336-716-9188
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1003
Practice Address - Country:US
Practice Address - Phone:336-716-6674
Practice Address - Fax:336-716-5324
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016025639207RC0000X
NC2014-00462207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200035803Medicaid
GA06BDJCHMedicare PIN
FL060061047OtherRAILROAD MEDICARE
FL51586ZMedicare PIN
GAP00616821OtherRR MEDICARE - GA
FL2595206-00Medicaid
FLE26754Medicare UPIN