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Individual
EDWARD JOSEPH LAVERTY
Active
Individual
EDWARD JOSEPH LAVERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
055.0031605
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00038485
BLUE CROSS
VT
05
—
0AP0387
—
VT
05
—
30010636
—
NH
01
—
341726
MVP
UT
01
—
542157
TRICARE
—
Enumeration date
10/28/2005
Last updated
09/26/2024
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