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NPI Code Detail

MEDICARE: LORI A LAVELLE DO

MEDICARE: LORI A LAVELLE DO
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
1207RR0500XRheumatology Physician0S012052PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1338517OTHERPABLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639162241
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI A LAVELLE DO
Provider Business Mailing Address
First Line : 175 MEADOWBROOK LN
Second Line :
City : DUNCANSVILLE
State : PA
Zip : 16635-8445
Country : US
Telephone Number : 814-693-0300
Fax Number : 814-693-0400
Provider Business Practice Location Address
First Line : 175 MEADOWBROOK LN
Second Line :
City : DUNCANSVILLE
State : PA
Zip : 16635-8445
Country : US
Telephone Number : 814-693-0300
Fax Number : 814-693-0400
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 05/09/2011

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1184084832 — MR. JASON GERALD BANKERT DO
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Directions to “ LORI A LAVELLE DO” Practice Location

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