MEDICARE: PHILIP H. LAVINE 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	2084P0800X	Psychiatry Physician	200101358	NC

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	:	1891791257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP H. LAVINE M.D.

Provider Business Mailing Address
First Line	:	1236 HUFFMAN MILL RD
Second Line	:	STE 2200
City	:	BURLINGTON
State	:	NC
Zip	:	27215-8700
Country	:	US
Telephone Number	:	336-675-0874
Fax Number	:	336-584-0210

Provider Business Practice Location Address
First Line	:	1236 HUFFMAN MILL RD
Second Line	:	STE 2200
City	:	BURLINGTON
State	:	NC
Zip	:	27215-8700
Country	:	US
Telephone Number	:	336-675-0874
Fax Number	:	336-584-0210

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

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	07/08/2007

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