Provider Demographics
NPI:1063558492
Name:EDWARD A LEMBERT MD INC
Entity type:Organization
Organization Name:EDWARD A LEMBERT MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-432-2600
Mailing Address - Street 1:7235 N 1ST ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2964
Mailing Address - Country:US
Mailing Address - Phone:559-432-2600
Mailing Address - Fax:
Practice Address - Street 1:7235 N 1ST ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2964
Practice Address - Country:US
Practice Address - Phone:559-432-2600
Practice Address - Fax:559-432-8518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC35648174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C356480Medicaid
CA1114920428OtherMEDICARE INDIVIDUAL NPI
CAZZZ04265ZOtherMEDICARE ID
CAA26039Medicare UPIN
CA000C356480Medicare PIN