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General NPI Number Information
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NPI Number | 1831276385
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Entity Type | Organization
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Legal Business Name | DOUGLAS J LAVENBURG MD PA
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 103 CHESAPEAKE BLVD STE C
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City | ELKTON
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State | MD
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Zip | 21921-6313
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Country | US
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Telephone | 410-392-6133
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Fax | 410-392-4958
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Provider Business Mailing Address
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Address Line | 103 CHESAPEAKE BLVD STE C
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City | ELKTON
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State | MD
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Zip | 21921-6313
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Country | US
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Telephone | 410-392-6133
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Fax | 410-392-4958
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Authorized Official
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Title or Position | PRESIDENT
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Name | DOUGLAS J LAVENBURG
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Credential | MD
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Telephone | 410-392-6133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | C10002822
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License Number State | DE
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