Provider Demographics
NPI:1144370743
Name:LAPORT, GINNA G (MD)
Entity type:Individual
Prefix:DR
First Name:GINNA
Middle Name:G
Last Name:LAPORT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GINNA
Other - Middle Name:
Other - Last Name:GASTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M,D
Mailing Address - Street 1:300 PASTEUR DR, RM H3249
Mailing Address - Street 2:STANFORD MEDICAL CENTER
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5623
Mailing Address - Country:US
Mailing Address - Phone:650-723-0822
Mailing Address - Fax:650-725-8950
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:RM H3249
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5623
Practice Address - Country:US
Practice Address - Phone:650-723-0822
Practice Address - Fax:650-725-8950
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51963207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF66663Medicare UPIN