Provider Demographics
NPI:1679597215
Name:JANET LORD MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JANET LORD MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:PHYLLIS
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-549-2038
Mailing Address - Street 1:3031 TELEGRAPH AVENUE
Mailing Address - Street 2:SUITE 241
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2052
Mailing Address - Country:US
Mailing Address - Phone:510-549-2038
Mailing Address - Fax:510-549-2690
Practice Address - Street 1:3031 TELEGRAPH AVE
Practice Address - Street 2:SUITE 241
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705
Practice Address - Country:US
Practice Address - Phone:510-549-2038
Practice Address - Fax:510-549-2690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40776225400000X
261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G407760Medicare ID - Type Unspecified
CAA48348Medicare UPIN