Healthcare Provider Details

I. General information

NPI: 1225561194
Provider Name (Legal Business Name): JAMES GREGORY LAVERY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 LAKE AVE
ASHTABULA OH
44004-3435
US

IV. Provider business mailing address

29111 CEDAR RD
MAYFIELD HEIGHTS OH
44124-4005
US

V. Phone/Fax

Practice location:
  • Phone: 440-443-0442
  • Fax: 440-755-8010
Mailing address:
  • Phone: 440-646-1600
  • Fax: 440-646-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.137506
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35.137506
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: