Provider Demographics
NPI:1003021148
Name:PETER LORBER, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PETER LORBER, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LORBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-977-0376
Mailing Address - Street 1:PO BOX 17959
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-0959
Mailing Address - Country:US
Mailing Address - Phone:213-977-0376
Mailing Address - Fax:
Practice Address - Street 1:1245 WILSHIRE BLVD
Practice Address - Street 2:SUITE 814
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4810
Practice Address - Country:US
Practice Address - Phone:213-481-0592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA253772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA25377AMedicare PIN
CAA25377Medicare PIN
CAWA25377BMedicare UPIN
CAA24411Medicare UPIN
CAHW7810Medicare PIN