Healthcare Provider Details

I. General information

NPI: 1811150576
Provider Name (Legal Business Name): ELEONORA G LAD MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CRIMSON OAK DR
DURHAM NC
27713-9297
US

IV. Provider business mailing address

1120 WELCH RD APT 231
PALO ALTO CA
94304-1922
US

V. Phone/Fax

Practice location:
  • Phone: 650-796-8526
  • Fax:
Mailing address:
  • Phone: 650-906-8526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2011-0050
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number2011-0050
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: