Healthcare Provider Details

I. General information

NPI: 1902994239
Provider Name (Legal Business Name): PETER E LAVINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 06/06/2020
Certification Date: 06/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 19TH ST NW STE 710
WASHINGTON DC
20036-3713
US

IV. Provider business mailing address

1145 19TH ST NW STE 710
WASHINGTON DC
20036-3713
US

V. Phone/Fax

Practice location:
  • Phone: 202-223-8600
  • Fax: 202-828-9376
Mailing address:
  • Phone: 202-223-8600
  • Fax: 202-828-9376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD40787
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101046643
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD18740
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: