Healthcare Provider Details

I. General information

NPI: 1750439956
Provider Name (Legal Business Name): PETER E. LAVINE, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 19TH ST NW SUITE 710
WASHINGTON DC
20036-3701
US

IV. Provider business mailing address

1145 19TH ST NW SUITE 710
WASHINGTON DC
20036-3701
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 TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberMD18740
License Number StateDC

VIII. Authorized Official

Name: DR. PETER E LAVINE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 202-223-8600