Healthcare Provider Details

I. General information

NPI: 1588354971
Provider Name (Legal Business Name): EMILY LAVELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W CUTHBERT BLVD STE 2
HADDON TOWNSHIP NJ
08108-3327
US

IV. Provider business mailing address

1 FEDERAL ST STE 200
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 856-546-7790
  • Fax:
Mailing address:
  • Phone: 848-288-6935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA13277600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: