Provider Demographics
NPI:1194898510
Name:ATHOS, LAURENCE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:
Last Name:ATHOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19830 LAKE CHABOT RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4063
Mailing Address - Country:US
Mailing Address - Phone:510-889-1677
Mailing Address - Fax:510-889-5823
Practice Address - Street 1:19830 LAKE CHABOT RD
Practice Address - Street 2:SUITE D
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4063
Practice Address - Country:US
Practice Address - Phone:510-889-1677
Practice Address - Fax:510-889-5823
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG34546207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G345460Medicaid
A45968Medicare UPIN
CA00G345460Medicaid