Basic Information
| Provider Information | |||||||||
| NPI: | 1295890440 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLUMBERG | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 DISTEL CIR STE 42 | ||||||||
| Address2: | |||||||||
| City: | LOS ALTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940221408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102048168 | ||||||||
| FaxNumber: | 5105067725 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 30TH ST STE 411 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102048168 | ||||||||
| FaxNumber: | 5105067725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 09/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD069008L | PA | N | Allopathic & Osteopathic Physicians | Surgery | 208C00000X | MD069008L | PA | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208C00000X | D0078428 | MD | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208C00000X | 605665 | CA | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208600000X | 605665 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.