| Lance Middleton M.d., Ph.d., P.c. | |
|
3030 Bridgeway Ste 212 Sausalito CA 94965-2898 | |
| (707) 504-9982 | |
| Not Available |
| Full Name | Lance Middleton M.d., Ph.d., P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 3030 Bridgeway Ste 212, Sausalito, California |
| Authorized Official Name and Position | Lance Middleton (PRESIDENT) |
| Authorized Official Contact | 2253354986 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lance Middleton M.d., Ph.d., P.c. 32 Leslie Ct Novato CA 94947-2921 Ph: (225) 335-4986 | Lance Middleton M.d., Ph.d., P.c. 3030 Bridgeway Ste 212 Sausalito CA 94965-2898 Ph: (707) 504-9982 |
| NPI Number | 1821798315 |
|---|---|
| Provider Enumeration Date | 03/06/2023 |
| Last Update Date | 03/06/2023 |
| Certification Date | 03/04/2023 |
| Medicare PECOS PAC ID | 9436503406 |
|---|---|
| Medicare Enrollment ID | O20230925001639 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821798315 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Lance Wade Middleton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730686841 PECOS PAC ID: 7719313493 Enrollment ID: I20220329002489 |
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