Provider Demographics
NPI:1023152196
Name:LAVERY, ADRIAN P (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:P
Last Name:LAVERY
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Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:11175 CAMPUS STREET
Mailing Address - Street 2:COLEMAN PAVILION SUITE 11121 DEPARTMENT OF NEONATOLOGY
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354
Mailing Address - Country:US
Mailing Address - Phone:909-651-5746
Mailing Address - Fax:909-558-0298
Practice Address - Street 1:11175 CAMPUS STREET
Practice Address - Street 2:COLEMAN PAVILION SUITE 11121 DEPARTMENT OF NEONATOLOGY
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354
Practice Address - Country:US
Practice Address - Phone:909-651-5746
Practice Address - Fax:909-558-0298
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2016-03-24
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Provider Licenses
StateLicense IDTaxonomies
OH35.089269208000000X
GA0604002080N0001X
CAA1167632080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I05664Medicare UPIN