Provider Demographics
NPI:1932105723
Name:DORNBRAND, LAURIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:DORNBRAND
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 1:103 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2415
Mailing Address - Country:US
Mailing Address - Phone:510-547-7950
Mailing Address - Fax:
Practice Address - Street 1:ON LOK SENIOR HEALTH - INSTITUTE ON AGING
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94155-0001
Practice Address - Country:US
Practice Address - Phone:415-447-1000
Practice Address - Fax:415-447-1035
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33377207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC87766Medicare UPIN