| M Lavian Md Llc | |
|
129 Wickham Ave Middletown NY 10940-3714 | |
| (845) 341-1805 | |
| (845) 342-9218 |
| Full Name | M Lavian Md Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 129 Wickham Ave, Middletown, New York |
| Authorized Official Name and Position | Manouchehr Lavian (OWNER) |
| Authorized Official Contact | 8453411805 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| M Lavian Md Llc 129 Wickham Ave Middletown NY 10940-3714 Ph: (845) 341-1805 | M Lavian Md Llc 129 Wickham Ave Middletown NY 10940-3714 Ph: (845) 341-1805 |
| NPI Number | 1114282274 |
|---|---|
| Provider Enumeration Date | 07/05/2012 |
| Last Update Date | 11/20/2012 |
| Medicare PECOS PAC ID | 0648421818 |
|---|---|
| Medicare Enrollment ID | O20121115000626 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114282274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 163228-1 (New York) | Primary |
| Provider Name | Manouchehr Lavian |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013922491 PECOS PAC ID: 5991691404 Enrollment ID: I20121206000320 |
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