Provider Demographics
NPI:1821057050
Name:CARLLEY, LORELLE EILEEN (MD)
Entity Type:Individual
Prefix:
First Name:LORELLE
Middle Name:EILEEN
Last Name:CARLLEY
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 1:350 HAWTHORNE AVE
Mailing Address - Street 2:DEPT. OF PATHOLOGY
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3108
Mailing Address - Country:US
Mailing Address - Phone:510-869-6567
Mailing Address - Fax:510-869-6707
Practice Address - Street 1:350 HAWTHORNE AVE
Practice Address - Street 2:DEPT. OF PATHOLOGY
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3108
Practice Address - Country:US
Practice Address - Phone:510-869-6567
Practice Address - Fax:510-869-6707
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71144207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI06976Medicare UPIN
CA00A711440Medicare PIN