Individual
DR. KELLY M. LAVERDURE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
750 BRUNSWICK AVE, TRENTON, NJ 19178-8567
(609) 815-7810
(609) 815-7814
Mailing address
P.O. BOX 8500-8567, PHILADELPHIA, PA 19178-8567
(609) 815-7887
(215) 860-7754
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS013010
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1011991960001
—
PA
Enumeration date
05/23/2005
Last updated
08/30/2012
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