MEDICARE: DR. LAURIE DORNBRAND M.D.

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	G33377	CA

General Provider Information

NPI Number	:	1932105723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE DORNBRAND M.D.

Provider Business Mailing Address
First Line	:	103 PLAZA DR
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2415
Country	:	US
Telephone Number	:	510-547-7950
Fax Number	:

Provider Business Practice Location Address
First Line	:	ON LOK SENIOR HEALTH - INSTITUTE ON AGING
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94155-0001
Country	:	US
Telephone Number	:	415-447-1000
Fax Number	:	415-447-1035

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

Provider Enumeration Date	:	06/26/2005
Last Update Date	:	07/08/2007

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