Individual
EDWARD JOSEPH LAVERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
137 MAIN ST STE 102, NEWPORT, VT 05855-4415
(802) 995-2412
(802) 334-7991
Mailing address
165 SHERMAN DR, ST JOHNSBURY, VT 05819-9811
(802) 748-9405
(802) 748-4540
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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