MEDICARE: DR. MARC ROBERT LEBED 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
1	207VM0101X	Maternal & Fetal Medicine Physician	G40402	CA

General Provider Information

NPI Number	:	1740401652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC ROBERT LEBED MD

Provider Business Mailing Address
First Line	:	387 MIRAMAR LN
Second Line	:
City	:	SHELL BEACH
State	:	CA
Zip	:	93449-1542
Country	:	US
Telephone Number	:	805-773-5661
Fax Number	:	805-773-8029

Provider Business Practice Location Address
First Line	:	387 MIRAMAR LN
Second Line	:
City	:	SHELL BEACH
State	:	CA
Zip	:	93449-1542
Country	:	US
Telephone Number	:	805-773-5661
Fax Number	:	805-773-8029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	07/08/2007

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