Active NPI
Marek Michal Lorenc, MD
- Procedural Dermatology Physician
- Santa Rosa, CA
National Provider Identifier
1992813588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Procedural Dermatology Physician
- License
- G53057
- Practice address
- 3562 Round Barn Cir
Suite 320
Santa Rosa, CA 95403-0179 - Phone
- (707) 578-1900
- Fax
- (707) 578-1111
- NPI assigned
- Aug 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Procedural Dermatology Physician | 207NS0135X | G53057 | CA | Primary |
Addresses
Primary practice location
3562 Round Barn Cir
Suite 320
Santa Rosa, CA 95403-0179
Mailing address
3562 Round Barn Cir
Suite 320
Santa Rosa, CA 95403-0179
Phone (707) 578-1900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2018 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53057 | CA | MD | Periodontist |
| G53057 | CA | MD | Procedural Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315267200000",
"number": "1992813588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3562 ROUND BARN CIR",
"address_2": "SUITE 320",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954030179",
"telephone_number": "707-578-1900",
"fax_number": "707-578-1111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3562 ROUND BARN CIR",
"address_2": "SUITE 320",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954030179",
"telephone_number": "707-578-1900",
"fax_number": "707-578-1111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LORENC",
"first_name": "MAREK",
"middle_name": "MICHAL",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-25",
"last_updated": "2011-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "207NS0135X",
"taxonomy_group": "",
"desc": "Dermatology, Procedural Dermatology",
"state": "CA",
"license": "G53057",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.