Provider Demographics
NPI:1750560728
Name:MARY ANN LAVERY MD
Entity type:Organization
Organization Name:MARY ANN LAVERY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LAVERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-871-8933
Mailing Address - Street 1:27059 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4064
Mailing Address - Country:US
Mailing Address - Phone:440-871-8933
Mailing Address - Fax:440-899-9462
Practice Address - Street 1:27059 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4064
Practice Address - Country:US
Practice Address - Phone:440-871-8933
Practice Address - Fax:440-899-9462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5683020001Medicare NSC
OH9313562Medicare PIN