MEDICARE: MACKENZIE ANN LAVELY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant	MA063613	PA

General Provider Information

NPI Number	:	1619610805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE ANN LAVELY PA-C

Provider Business Mailing Address
First Line	:	810 CLAIRTON BLVD STE 400
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15236-5511
Country	:	US
Telephone Number	:	412-650-1150
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 CLAIRTON BLVD STE 400
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15236-5511
Country	:	US
Telephone Number	:	412-650-1150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	01/16/2023

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Directions to “ MACKENZIE ANN LAVELY PA-C” Practice Location

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