Provider Demographics
NPI:1154307387
Name:LAVOIE, MARIE-LYNE (MD)
Entity type:Individual
Prefix:
First Name:MARIE-LYNE
Middle Name:
Last Name:LAVOIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 LENDEW ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7007
Mailing Address - Country:US
Mailing Address - Phone:336-273-2835
Mailing Address - Fax:336-273-1948
Practice Address - Street 1:719 GREEN VALLEY RD STE 305
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7026
Practice Address - Country:US
Practice Address - Phone:336-275-5391
Practice Address - Fax:336-275-4702
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801695207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891244WMedicaid
NCH09328Medicare UPIN
NC2279961Medicare ID - Type Unspecified