Provider Demographics
NPI:1386603769
Name:LAVRICH, JUDITH B (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:B
Last Name:LAVRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1568 WOODBOURNE RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19057-1508
Mailing Address - Country:US
Mailing Address - Phone:215-943-7800
Mailing Address - Fax:215-943-5799
Practice Address - Street 1:1568 WOODBOURNE RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19057-1508
Practice Address - Country:US
Practice Address - Phone:215-943-7800
Practice Address - Fax:215-943-5799
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041810L207W00000X
NJ25MA05502300207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E72980Medicare UPIN
PA653273FMMMedicare ID - Type UnspecifiedPA INDIVIDUAL MEDICARE
NJ707672CCUMedicare ID - Type UnspecifiedNJ INDIVIDUAL MEDICARE