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Individual
DR. MARK EDWARD LAVALLEE
Active
Individual
DR. MARK EDWARD LAVALLEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD060390L
PA
207QS0010X
Sports Medicine (Family Medicine) Physician
01049328A
IN
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
MD060390L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002980953
HIGHMARK BLUE SHIELD
PA
05
—
068809600
—
MD
05
—
102855069
—
PA
05
—
200198600
—
IN
Enumeration date
11/02/2005
Last updated
04/12/2024
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