Provider Demographics
NPI:1912140906
Name:LAVERGNE, DOUGLAS ARTHUR
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ARTHUR
Last Name:LAVERGNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 SARATOGA ROAD
Mailing Address - Street 2:PROFESSIONAL BUILDING SUITE 1
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302
Mailing Address - Country:US
Mailing Address - Phone:518-399-3838
Mailing Address - Fax:518-399-3426
Practice Address - Street 1:133 SARATOGA RD
Practice Address - Street 2:PROFESSIONAL BUILDING SUITE 1
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-4108
Practice Address - Country:US
Practice Address - Phone:518-399-3838
Practice Address - Fax:518-399-3426
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002982171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist