Provider Demographics
NPI:1063609725
Name:ELISABETH B LERNHARDT MD INC APC
Entity type:Organization
Organization Name:ELISABETH B LERNHARDT MD INC APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:BRIGITTE
Authorized Official - Last Name:LERNHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-432-1300
Mailing Address - Street 1:11286 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946-9413
Mailing Address - Country:US
Mailing Address - Phone:530-432-1300
Mailing Address - Fax:530-432-5214
Practice Address - Street 1:11286 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95946-9413
Practice Address - Country:US
Practice Address - Phone:530-432-1300
Practice Address - Fax:530-432-5214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA047847207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A478471Medicaid
CAA47847OtherLICENCE
CABL247847OtherDEA
CAF21308Medicare UPIN
CA00A478471Medicaid