Provider Demographics
NPI:1194724419
Name:LAVIETES, WILLIAM PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PAUL
Last Name:LAVIETES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2800 QUARRY LAKE DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3770
Mailing Address - Country:US
Mailing Address - Phone:410-486-2000
Mailing Address - Fax:410-486-0825
Practice Address - Street 1:2800 QUARRY LAKE DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3770
Practice Address - Country:US
Practice Address - Phone:410-486-2000
Practice Address - Fax:410-486-0825
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2015-06-02
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Provider Licenses
StateLicense IDTaxonomies
PAMD043413L207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E72791Medicare UPIN
000213Medicare ID - Type Unspecified