Basic Information
| Provider Information | |||||||||
| NPI: | 1154307387 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAVOIE | ||||||||
| FirstName: | MARIE-LYNE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1908 LENDEW ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362732835 | ||||||||
| FaxNumber: | 3362731948 | ||||||||
| Practice Location | |||||||||
| Address1: | 719 GREEN VALLEY RD STE 305 | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362755391 | ||||||||
| FaxNumber: | 3362754702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2005 | ||||||||
| LastUpdateDate: | 08/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 9801695 | NC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 891244W | 05 | NC | MEDICAID |