Provider Demographics
NPI:1093817728
Name:EPSTEIN, LAWRENCE ALAN (MD)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:ALAN
Last Name:EPSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HOSPITAL DR
Mailing Address - Street 2:BLDG 11, SUITE E
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4106
Mailing Address - Country:US
Mailing Address - Phone:650-625-0800
Mailing Address - Fax:650-934-2409
Practice Address - Street 1:2500 HOSPITAL DR
Practice Address - Street 2:BLDG 11, SUITE E
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4106
Practice Address - Country:US
Practice Address - Phone:650-625-0800
Practice Address - Fax:650-934-2409
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC24787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C247870OtherBLUE SHIELD
CA0004050567OtherAETNA
A88817Medicare UPIN
CA00C247870Medicare ID - Type Unspecified