Provider Demographics
NPI:1285815423
Name:DAVID J LOURIE M D INC
Entity Type:Organization
Organization Name:DAVID J LOURIE M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LOURIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-793-7955
Mailing Address - Street 1:10 CONGRESS ST STE 512
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3042
Mailing Address - Country:US
Mailing Address - Phone:626-793-7955
Mailing Address - Fax:626-793-7577
Practice Address - Street 1:10 CONGRESS ST STE 512
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3042
Practice Address - Country:US
Practice Address - Phone:626-793-7955
Practice Address - Fax:626-793-7577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19133Medicare PIN