Provider Demographics
NPI:1013966571
Name:LOURIE, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:LOURIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CONGRESS ST STE 512
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3042
Mailing Address - Country:US
Mailing Address - Phone:626-793-7955
Mailing Address - Fax:626-793-7577
Practice Address - Street 1:10 CONGRESS ST STE 512
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3042
Practice Address - Country:US
Practice Address - Phone:626-793-7955
Practice Address - Fax:626-793-7577
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70873208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19133Medicare PIN
CAF55836Medicare UPIN