Healthcare Provider Details

I. General information

NPI: 1790937506
Provider Name (Legal Business Name): LORI ELLEN SHORE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LORI ELLEN MOURATOFF LORI SHORE M.D.

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 TELEGRAPH AVE
BERKELEY CA
94705-2017
US

IV. Provider business mailing address

188 CAPRICORN AVE
OAKLAND CA
94611-1943
US

V. Phone/Fax

Practice location:
  • Phone: 510-224-4181
  • Fax: 510-848-9970
Mailing address:
  • Phone: 510-326-4649
  • Fax: 510-848-9970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA64852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: