Individual
PABLO LUIS GONZALEZ LAVAGNINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
602 S ATWOOD RD, SUITE 105, BEL AIR, MD 21014-4172
(410) 836-0354
(410) 836-0170
Mailing address
2234 COLONIAL BLVD, MANAGED CARE DEPT., FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
D66490
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6882-0004
CARE FIRST BCBS-DC
MD
01
—
88100501
CARE FIRST BCBS-MARYLAND
MD
01
—
P00441742
RAILROAD MEDICARE #
MD
Enumeration date
08/06/2007
Last updated
03/03/2008
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