Provider Demographics
NPI:1891791257
Name:LAVINE, PHILIP H (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:H
Last Name:LAVINE
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 1:1236 HUFFMAN MILL RD
Mailing Address - Street 2:STE 2200
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8700
Mailing Address - Country:US
Mailing Address - Phone:336-675-0874
Mailing Address - Fax:336-584-0210
Practice Address - Street 1:1236 HUFFMAN MILL RD
Practice Address - Street 2:STE 2200
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-675-0874
Practice Address - Fax:336-584-0210
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001013582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC130JAMedicaid
NC2297185Medicare ID - Type Unspecified
NC130JAMedicaid