Provider Demographics
NPI:1124168760
Name:PIAZZA, LAWRENCE DANA (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:DANA
Last Name:PIAZZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2970 HILLTOP MALL RD STE 203
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1949
Mailing Address - Country:US
Mailing Address - Phone:510-222-8000
Mailing Address - Fax:510-222-2690
Practice Address - Street 1:2970 HILLTOP MALL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-1947
Practice Address - Country:US
Practice Address - Phone:510-222-8000
Practice Address - Fax:510-222-2690
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2009-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG598202083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACI784ZMedicare UPIN
CAZZZ07334ZMedicare PIN