Provider Demographics
NPI:1811902786
Name:LAVIN, NORMAN (MD)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:LAVIN
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 1:18370 BURBANK BLVD
Mailing Address - Street 2:SUITE #204
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2851
Mailing Address - Country:US
Mailing Address - Phone:818-345-7792
Mailing Address - Fax:818-345-9052
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:SUITE #204
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2851
Practice Address - Country:US
Practice Address - Phone:818-345-7792
Practice Address - Fax:818-345-9052
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16804207RE0101X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG16804OtherSTATE LICENSE
CAG16804OtherSTATE LICENSE
A90452Medicare UPIN