Provider Demographics
NPI:1154373405
Name:LAVALETTE, JOHN HOWARD (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:HOWARD
Last Name:LAVALETTE
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 1:546 CROMWELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067
Mailing Address - Country:US
Mailing Address - Phone:860-721-7561
Mailing Address - Fax:860-721-9199
Practice Address - Street 1:31 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033
Practice Address - Country:US
Practice Address - Phone:860-721-7561
Practice Address - Fax:860-721-9199
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037023208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00137023800Medicaid
00948ROtherBCBS UPIN
CT0370230688OtherCT CARE
CT010037023CT01OtherBCBS
OV8907OtherHEALTHNET
CTP1102930OtherOXFORD