Individual
DOUGLAS LAVENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
103 CHESAPEAKE BLVD, STE C, ELKTON, MD 21921
(410) 392-6133
(410) 392-4958
Mailing address
103 CHESAPEAKE BLVD, STE C, ELKTON, MD 21921
(410) 392-6133
(410) 392-4958
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
C10002822
DE
207W00000X
Ophthalmology Physician
Primary
D0036586
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000542402
—
DE
05
—
116251900
—
MD
Enumeration date
05/02/2006
Last updated
04/13/2012
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