Provider Demographics
NPI:1730157249
Name:LARAVIA, DENNIS A (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:A
Last Name:LARAVIA
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 1:900 CARTER STREET
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373
Mailing Address - Country:US
Mailing Address - Phone:318-336-4780
Mailing Address - Fax:318-336-4783
Practice Address - Street 1:900 CARTER STREET
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373
Practice Address - Country:US
Practice Address - Phone:318-336-4780
Practice Address - Fax:318-336-4783
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine