Individual
DR. KENNETH GORDON LAVELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 S 11TH ST, PHILADELPHIA, PA 19107-4824
(215) 955-6000
Mailing address
111 S 11TH ST, PHILADELPHIA, PA 19107-4824
(215) 955-6000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD429880
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0138789
—
NJ
05
—
101976767
—
PA
Enumeration date
05/08/2007
Last updated
06/06/2013
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