Provider Demographics
NPI:1902994239
Name:LAVINE, PETER E (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:E
Last Name:LAVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 19TH ST NW STE 710
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-3713
Mailing Address - Country:US
Mailing Address - Phone:202-223-8600
Mailing Address - Fax:202-828-9376
Practice Address - Street 1:1145 19TH ST NW STE 710
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3713
Practice Address - Country:US
Practice Address - Phone:202-223-8600
Practice Address - Fax:202-828-9376
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2020-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD40787207X00000X
VA0101046643207X00000X
DCMD18740207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F12160Medicare UPIN
704280Medicare PIN