Provider Demographics
NPI:1710128558
Name:GINSBERG, MICHAEL LANE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LANE
Last Name:GINSBERG
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 1:2458 HILBORN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1072
Mailing Address - Country:US
Mailing Address - Phone:707-646-5500
Mailing Address - Fax:707-646-5501
Practice Address - Street 1:2458 HILBORN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1072
Practice Address - Country:US
Practice Address - Phone:707-646-5500
Practice Address - Fax:707-646-5501
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1064862080A0000X
NY2505592080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine