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General NPI Number Information
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NPI Number | 1902564800
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Entity Type | Individual
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Provider Name | DANIEL WALTER LAVIN
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Gender | Male
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 31 DOG RIVER DRIVE
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City | NORTHFIELD
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State | VT
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Zip | 05663
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Country | US
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Telephone | 802-485-8550
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Fax |
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Provider Business Mailing Address
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Address Line | 85 EDGEBROOK RD
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City | FRAMINGHAM
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State | MA
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Zip | 01701-3813
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Country | US
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Telephone | 508-788-5567
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Fax |
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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 | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | 105501
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License Number State | VT
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