Individual
DR. MICHAEL A LAVALLEE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
4 SHAWS CV, SUITE 204, NEW LONDON, CT 06320-4956
(860) 447-2377
Mailing address
4 SHAWS CV, SUITE 204, NEW LONDON, CT 06320-4956
(860) 447-2377
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
051963
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051963
LICENSE
CT
Enumeration date
06/02/2009
Last updated
05/29/2013
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