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NPI Code Detail

MEDICARE: ARIADNE GUINEVERE LIE MD

MEDICARE: ARIADNE GUINEVERE LIE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician252084NY
2208000000XPediatrics Physician252084NY
3208000000XPediatrics PhysicianC175923CA
4207R00000XInternal Medicine PhysicianC175923CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245243484
Entity Type Code : Individual
Provider Name (Legal Business Name) : ARIADNE GUINEVERE LIE MD
Provider Business Mailing Address
First Line : 5800 HOLLIS ST
Second Line :
City : EMERYVILLE
State : CA
Zip : 94608-2016
Country : US
Telephone Number : 510-806-2238
Fax Number :
Provider Business Practice Location Address
First Line : 5800 HOLLIS ST
Second Line :
City : EMERYVILLE
State : CA
Zip : 94608-2016
Country : US
Telephone Number : 510-806-2238
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 04/19/2024

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Directions to “ ARIADNE GUINEVERE LIE MD” Practice Location

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