Provider Demographics
NPI:1447250998
Name:EAST OAKLAND OBS GYN MED GP INC
Entity type:Organization
Organization Name:EAST OAKLAND OBS GYN MED GP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LAMPLEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:510-638-1258
Mailing Address - Street 1:PO BOX 6097
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94603-0097
Mailing Address - Country:US
Mailing Address - Phone:510-638-1250
Mailing Address - Fax:510-638-2590
Practice Address - Street 1:9925 INTERNATIONAL BLVD
Practice Address - Street 2:STE 1
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94603
Practice Address - Country:US
Practice Address - Phone:510-638-1250
Practice Address - Fax:510-638-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG100160207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G100160Medicaid
CA00G100160Medicaid
CAA37481Medicare UPIN