Basic Information
| Provider Information | |||||||||
| NPI: | 1326608779 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAVERGNE | ||||||||
| FirstName: | PASCAL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 983 BOULEVARD RAYMOND | ||||||||
| Address2: | |||||||||
| City: | QUEBEC | ||||||||
| State: | QC | ||||||||
| PostalCode: | G1B1J6 | ||||||||
| CountryCode: | CA | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 11TH ST, THOMAS JEFFERSON UNIVERSITY | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2019 | ||||||||
| LastUpdateDate: | 07/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | MD466286 | PA | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.