Basic Information
| Provider Information | |||||||||
| NPI: | 1750511077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAVERRIERE | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | KIRSTEN | ||||||||
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| Credential: | M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3401 CIVIC CENTER BLVD | ||||||||
| Address2: | SUITE 9329 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155901858 | ||||||||
| FaxNumber: | 2674259331 | ||||||||
| Practice Location | |||||||||
| Address1: | 34TH ST. & CIVIC CENTER BLVD | ||||||||
| Address2: | ROOM 9NW55 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155902437 | ||||||||
| FaxNumber: | 2155902768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2009 | ||||||||
| LastUpdateDate: | 07/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP3000X | MD445220 | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology | 2080P0203X | MD445220 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | 208000000X | MT195010 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD445220 | PA | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.