Healthcare Provider Details

I. General information

NPI: 1194724419
Provider Name (Legal Business Name): WILLIAM PAUL LAVIETES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 QUARRY LAKE DRIVE SUITE 100
BALTIMORE MD
21209-3770
US

IV. Provider business mailing address

2800 QUARRY LAKE DRIVE SUITE 100
BALTIMORE MD
21209-3770
US

V. Phone/Fax

Practice location:
  • Phone: 410-486-2000
  • Fax: 410-486-0825
Mailing address:
  • Phone: 410-486-2000
  • Fax: 410-486-0825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD043413L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: