Provider Demographics
NPI:1790937506
Name:SHORE, LORI ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ELLEN
Last Name:SHORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:ELLEN
Other - Last Name:MOURATOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LORI SHORE MD
Mailing Address - Street 1:188 CAPRICORN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1943
Mailing Address - Country:US
Mailing Address - Phone:510-594-1448
Mailing Address - Fax:510-594-8323
Practice Address - Street 1:2417 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4515
Practice Address - Country:US
Practice Address - Phone:510-625-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64852207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine