Provider Demographics
NPI:1629153598
Name:SCHWEITZER, LAURIE ELLEN (MD)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ELLEN
Last Name:SCHWEITZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 REGENT ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2152
Mailing Address - Country:US
Mailing Address - Phone:510-548-1717
Mailing Address - Fax:510-548-1715
Practice Address - Street 1:2999 REGENT ST STE 300
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705
Practice Address - Country:US
Practice Address - Phone:510-548-1717
Practice Address - Fax:510-548-1715
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71395207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G713951Medicaid
CA00G713951Medicaid
CA00G713950Medicare ID - Type Unspecified