MEDICARE: DR. NEIL S LAVA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	121255-1	NY
2	2084N0400X	Neurology Physician	60115	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013900919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEIL S LAVA M.D.

Provider Business Mailing Address
First Line	:	12 EXECUTIVE PARK DRIVE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2206
Country	:	US
Telephone Number	:	404-778-3444
Fax Number	:	404-712-7464

Provider Business Practice Location Address
First Line	:	12 EXECUTIVE PARK DRIVE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2206
Country	:	US
Telephone Number	:	404-778-3444
Fax Number	:	404-712-7464

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	10/22/2015

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