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General NPI Number Information
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NPI Number | 1457346397
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Entity Type | Individual
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Provider Name | CLEMENT W LAVIN MD
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Gender | Male
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 12/03/2014
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Provider Practice Location Address
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Address Line | 32 COLLEGE AVE SUITE 304
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City | WATERVILLE
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State | ME
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Zip | 04901-6100
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Country | US
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Telephone | 207-872-9564
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Fax | 207-861-5458
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Provider Business Mailing Address
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Address Line | 25 FIRST PK SUITE C
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City | WATERVILLE
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State | ME
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Zip | 04901-6100
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Country | US
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Telephone | 207-872-9564
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Fax | 207-861-5458
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 013046
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License Number State | ME
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