Active NPI
Antoinette Lee Lavalley, MD
- Neuroradiology Physician
- Toledo, OH
National Provider Identifier
1235118480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neuroradiology Physician
- License
- 35052406
- Practice address
- 2658 W. Laskey Road
2ND Floor
Toledo, OH 43613-3288 - Phone
- (419) 473-8105
- Fax
- (419) 254-2121
- NPI assigned
- Jan 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neuroradiology Physician | 2085N0700X | 35052406 | OH | Primary |
Addresses
Primary practice location
2658 W. Laskey Road
2ND Floor
Toledo, OH 43613-3288
Mailing address
3455 Mill Run Drive
Suite 450
Hilliard, OH 43026-9083
Phone (614) 771-2222
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 711108 | Medicaid | OH | |
| 35052406 | Other | OH | LICENSE NUMBER |
| 0711108 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35052406 | OH | MD | Neuroradiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fauster Cameron Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1269475200000",
"number": "1235118480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3455 MILL RUN DRIVE",
"address_2": "SUITE 450",
"city": "HILLIARD",
"state": "OH",
"postal_code": "430269083",
"telephone_number": "614-771-2222",
"fax_number": "614-771-2221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2658 W. LASKEY ROAD",
"address_2": "2ND FLOOR",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436133288",
"telephone_number": "419-473-8105",
"fax_number": "419-254-2121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAVALLEY",
"first_name": "ANTOINETTE",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-15",
"last_updated": "2010-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "OH",
"license": "35052406",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "711108",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "35052406",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0711108",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Toledo, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.