Basic Information
| Provider Information | |||||||||
| NPI: | 1306092838 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAY AREA PULMONARY AND CRITICAL CARE MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1525 WEBSTER ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945334997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074232506 | ||||||||
| FaxNumber: | 7074291158 | ||||||||
| Practice Location | |||||||||
| Address1: | 1525 WEBSTER ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945334997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074232506 | ||||||||
| FaxNumber: | 7074291158 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2008 | ||||||||
| LastUpdateDate: | 11/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | ANIT | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7074232506 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | A76092 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.