Organization
DOUGLAS J LAVENBURG MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS J LAVENBURG MD (PRESIDENT)
(410) 392-6133
Entity
Organization
Contact information
Practice address
103 CHESAPEAKE BLVD STE C, ELKTON, MD 21921-6313
(410) 392-6133
(410) 392-4958
Mailing address
103 CHESAPEAKE BLVD STE C, ELKTON, MD 21921-6313
(410) 392-6133
(410) 392-4958
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
C10002822
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000542402
—
DE
05
—
116251900
—
MD
Enumeration date
11/01/2006
Last updated
02/06/2025
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