Healthcare Provider Details

I. General information

NPI: 1295874816
Provider Name (Legal Business Name): RICHARD CECIL LAVY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 PATTERSON AVE MARYLAND PROFESSIONAL VOLUNTEER CORPS
BALTIMORE MD
21215-2222
US

IV. Provider business mailing address

300 WILLOW VALLEY LAKES DR APT. C-124
WILLOW STREET PA
17584-9442
US

V. Phone/Fax

Practice location:
  • Phone: 717-464-4876
  • Fax:
Mailing address:
  • Phone: 717-464-4876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberD0007766
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: