Provider Demographics
NPI:1134380918
Name:PANOSSIAN, LORI A (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:PANOSSIAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 MUIR RD
Mailing Address - Street 2:BUILDING 21, CENTER FOR NEUROSCIENCES (612/127)
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4668
Mailing Address - Country:US
Mailing Address - Phone:916-843-7306
Mailing Address - Fax:925-372-2111
Practice Address - Street 1:150 MUIR RD
Practice Address - Street 2:BUILDING 21, CENTER FOR NEUROSCIENCES (612/127)
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4668
Practice Address - Country:US
Practice Address - Phone:925-372-2398
Practice Address - Fax:925-372-2111
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1006572084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine