Provider Demographics
NPI:1174824544
Name:LAWRENCE A TEPLIN DPM
Entity type:Organization
Organization Name:LAWRENCE A TEPLIN DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TEPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:925-362-1080
Mailing Address - Street 1:909 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:SUITE #118
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4038
Mailing Address - Country:US
Mailing Address - Phone:925-362-1080
Mailing Address - Fax:925-362-1083
Practice Address - Street 1:909 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE #118
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4038
Practice Address - Country:US
Practice Address - Phone:925-362-1080
Practice Address - Fax:925-362-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1397213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E13920Medicaid
CA0654360001Medicare NSC
CA000E13970Medicare PIN
CAT10937Medicare UPIN