Provider Demographics
NPI:1386857746
Name:LAVIGNE, MARCIE (MD)
Entity type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:
Last Name:LAVIGNE
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 1:1044 S 88TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9417
Mailing Address - Country:US
Mailing Address - Phone:303-666-7119
Mailing Address - Fax:303-666-0220
Practice Address - Street 1:1044 S 88TH ST STE 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9417
Practice Address - Country:US
Practice Address - Phone:303-666-7119
Practice Address - Fax:303-666-0220
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COH58406Medicare UPIN