Provider Demographics
NPI:1548310824
Name:LAVIN, LINDA SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SUSAN
Last Name:LAVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:LAVIN
Other - Last Name:LESKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:700 LAWN AVE
Mailing Address - Street 2:GRAND VIEW HOSPITAL
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1548
Mailing Address - Country:US
Mailing Address - Phone:215-453-4522
Mailing Address - Fax:215-453-4167
Practice Address - Street 1:700 LAWN AVE
Practice Address - Street 2:GRAND VIEW HOSPITAL
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1548
Practice Address - Country:US
Practice Address - Phone:215-453-4522
Practice Address - Fax:215-453-4167
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020465E207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C32175Medicare UPIN