Individual
MARC A LAVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3998 RED LION RD, STE 305, PHILADELPHIA, PA 19114-1436
(215) 632-8882
(215) 632-2232
Mailing address
PO BOX 8500-6335, PHILADELPHIA, PA 19178-6335
(215) 632-8882
(215) 632-2232
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD070920L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017988220001
—
PA
01
—
0800550000
KEYSTONE IBC
PA
01
—
127376
HIGHMARK BLUE SHIELD
PA
01
—
232691968
HEALTH PARTNERS
PA
01
—
30106257
KEYSTONE MERCY
PA
01
—
8317363
AETNA
PA
01
—
P01043213
RAILROAD MEDICARE
PA
Enumeration date
05/31/2005
Last updated
11/05/2012
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