Healthcare Provider Details

I. General information

NPI: 1295712792
Provider Name (Legal Business Name): LORNE K ROSENFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 EL CAMINO REAL #405
BURLINGAME CA
94010-3228
US

IV. Provider business mailing address

610 ANSEL RD #5
BURLINGAME CA
94010-4069
US

V. Phone/Fax

Practice location:
  • Phone: 650-692-0467
  • Fax: 650-692-0110
Mailing address:
  • Phone: 650-343-9746
  • Fax: 650-343-9746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG46372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: