Basic Information
| Provider Information | |||||||||
| NPI: | 1942254198 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAY AREA RADIOLOGISTS, A MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6102 | ||||||||
| Address2: | |||||||||
| City: | NOVATO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949486102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158843404 | ||||||||
| FaxNumber: | 4158831836 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 HYDE ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941094806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153536390 | ||||||||
| FaxNumber: | 4153536396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 02/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | MAINZER | ||||||||
| AuthorizedOfficialFirstName: | FRANK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4157505770 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | CR1199 | 01 | RAILROAD MEDICARE PIN | OTHER | GR0013000 | 05 | CA | MEDICAID |