Provider Demographics
NPI:1902564800
Name:LAVIN, DANIEL WALTER
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:WALTER
Last Name:LAVIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 EDGEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-3813
Mailing Address - Country:US
Mailing Address - Phone:508-788-5567
Mailing Address - Fax:
Practice Address - Street 1:31 DOG RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:VT
Practice Address - Zip Code:05663
Practice Address - Country:US
Practice Address - Phone:802-485-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT105501146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT105501Medicaid