Provider Demographics
NPI:1215970538
Name:GOLDSCHLAGER, LEONORA FOX (MD)
Entity type:Individual
Prefix:DR
First Name:LEONORA
Middle Name:FOX
Last Name:GOLDSCHLAGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7464
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94120-7464
Mailing Address - Country:US
Mailing Address - Phone:415-502-7648
Mailing Address - Fax:415-502-8175
Practice Address - Street 1:1001 POTRERO AVENUE
Practice Address - Street 2:RM 5G1
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-3503
Practice Address - Fax:415-206-5447
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14678207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G146780Medicaid
CA060022312OtherRAILROAD MEDICARE
A89222Medicare UPIN
CA00G146780Medicaid