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Individual

LAURENCE J GAVIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
39TH AND MARKET ST, PHILADELPHIA, PA 19104
(215) 662-6963
Mailing address
51 N 39TH ST, PHILADELPHIA, PA 19104-2640

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD031733E
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0009756730001
PA
Enumeration date
06/22/2006
Last updated
02/18/2011
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