Provider Demographics
NPI:1871576603
Name:LORD, JANET PHYLLIS (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:PHYLLIS
Last Name:LORD
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 1:3031 TELEGRAPH AVE
Mailing Address - Street 2:STE 241
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2051
Mailing Address - Country:US
Mailing Address - Phone:510-549-2037
Mailing Address - Fax:510-549-2690
Practice Address - Street 1:3031 TELEGRAPH AVE
Practice Address - Street 2:STE 241
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2051
Practice Address - Country:US
Practice Address - Phone:510-549-2037
Practice Address - Fax:510-549-2690
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG40776225400000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA006407760Medicaid
CA006407760Medicaid
00G407760Medicare ID - Type Unspecified