Provider Demographics
NPI:1275718108
Name:MAREK MICHAL LORENC, M.D.
Entity Type:Organization
Organization Name:MAREK MICHAL LORENC, M.D.
Other - Org Name:DERMATOLOGY & COSMETIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PROPRIETOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAREK
Authorized Official - Middle Name:MICHAL
Authorized Official - Last Name:LORENC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-578-1900
Mailing Address - Street 1:3562 ROUND BARN CIR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-0179
Mailing Address - Country:US
Mailing Address - Phone:707-578-1900
Mailing Address - Fax:707-578-1111
Practice Address - Street 1:3562 ROUND BARN CIR
Practice Address - Street 2:SUITE 320
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-0179
Practice Address - Country:US
Practice Address - Phone:707-578-1900
Practice Address - Fax:707-578-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G530570Medicare PIN