Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | OS021384 | PA |
Y | 111NI0900X | Internist | OS021384 | PA |
N | 207RN0300X | Nephrologist | OS021384 | PA |
NPI | 1023428349 |
---|---|
Provider Name | Linda-Marie Ustaris Lavenburg |
First Address | Philadelphia, PA 19104-4238 |
Second Address | Philadelphia, PA 19104-4238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2014 |
Last Update Date | 24/11/2021 |