Provider Demographics
NPI:1962405449
Name:LAVELLE, JOHN PAUL (MB, BCH, FRCSI)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:LAVELLE
Suffix:
Gender:M
Credentials:MB, BCH, FRCSI
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Mailing Address - Street 1:3801 MIRANDA AVE
Mailing Address - Street 2:B3-117 BLDG 100 UROLOGY (#112)
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1207
Mailing Address - Country:US
Mailing Address - Phone:650-493-5000
Mailing Address - Fax:650-849-0319
Practice Address - Street 1:3801 MIRANDA AVE
Practice Address - Street 2:B3-117 BLDG 100 UROLOGY (#112)
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1207
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:650-849-0319
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200000870208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126KYMedicaid
2280556Medicare ID - Type Unspecified
H15869Medicare UPIN