Provider Demographics
NPI:1841463965
Name:JOHN LAVIN, M.D.P.A.
Entity type:Organization
Organization Name:JOHN LAVIN, M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:LAVIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:410-296-4040
Mailing Address - Street 1:7600 OSLER DR
Mailing Address - Street 2:STE 113
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7735
Mailing Address - Country:US
Mailing Address - Phone:410-296-4040
Mailing Address - Fax:410-296-4114
Practice Address - Street 1:7600 OSLER DR
Practice Address - Street 2:STE 113
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7735
Practice Address - Country:US
Practice Address - Phone:410-296-4040
Practice Address - Fax:410-296-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD20795207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD73912Medicare UPIN
MD428MMedicare PIN