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NPI Code Detail

MEDICARE: LIFELONG MEDICAL CARE

MEDICARE: LIFELONG MEDICAL CARE
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
11223G0001XGeneral Practice Dentistry
2207Q00000XFamily Medicine Physician
3171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1457758724
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFELONG MEDICAL CARE
Provider Business Mailing Address
First Line : PO BOX 11247
Second Line :
City : BERKELEY
State : CA
Zip : 94712-2247
Country : US
Telephone Number : 510-981-4122
Fax Number :
Provider Business Practice Location Address
First Line : 3075 ADELINE ST STE 280
Second Line :
City : BERKELEY
State : CA
Zip : 94703-2580
Country : US
Telephone Number : 510-225-6300
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. MARTY LYNCH
Credential :
Telephone Number : 510-981-4123
Provider Enumeration Date : 12/02/2014
Last Update Date : 03/31/2022

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Directions to “LIFELONG MEDICAL CARE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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