Provider Demographics
NPI:1922053081
Name:LIVINGSTON, LAWRENCE HART (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:HART
Last Name:LIVINGSTON
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 1:1060 SARATOGA AVE
Mailing Address - Street 2:STE 920
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3402
Mailing Address - Country:US
Mailing Address - Phone:408-243-6991
Mailing Address - Fax:
Practice Address - Street 1:1060 SARATOGA AVE
Practice Address - Street 2:STE 920
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-3402
Practice Address - Country:US
Practice Address - Phone:408-243-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27982207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G279820Medicaid
CAF09708Medicare UPIN
CA00G279820Medicaid
CA00G279823Medicare PIN