Provider Demographics
NPI:1245429232
Name:LAWRENCE M SCHALL, M.D., INC.
Entity Type:Organization
Organization Name:LAWRENCE M SCHALL, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESINDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-287-2847
Mailing Address - Street 1:815 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4440
Mailing Address - Country:US
Mailing Address - Phone:626-281-6268
Mailing Address - Fax:626-281-9397
Practice Address - Street 1:815 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4440
Practice Address - Country:US
Practice Address - Phone:626-281-6268
Practice Address - Fax:626-281-9397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A429500OtherBLUE SHIELD
CAW1069Medicaid
CAW1069Medicaid