Provider Demographics
NPI:1841321841
Name:OLDHAM, LAURIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:
Last Name:OLDHAM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 WEBSTER ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3117
Mailing Address - Country:US
Mailing Address - Phone:510-465-6600
Mailing Address - Fax:510-839-0806
Practice Address - Street 1:2350 PACHECO ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2018
Practice Address - Country:US
Practice Address - Phone:925-676-2600
Practice Address - Fax:925-680-0212
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 19052363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical