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Individual

MICHAEL TODD LAVELLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
700 E MOREHEAD ST STE 300, CHARLOTTE, NC 28202-2742
(704) 334-7800
(704) 414-7512
Mailing address
700 E MOREHEAD ST STE 300, CHARLOTTE, NC 28202-2742
(704) 334-7800
(704) 414-7512

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
200200391
NC
2085R0202X
Diagnostic Radiology Physician
23045
SC
2085R0202X
Diagnostic Radiology Physician
60.213907
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
89130Y2
NC
05
N00391
SC
01
NC 300130038
RR MEDICARE NC
NC
01
SC 300130040
RR MEDICARE SC
SC
Enumeration date
07/18/2005
Last updated
12/20/2017
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