Provider Demographics
NPI:1003924432
Name:OAKLAND MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:OAKLAND MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHITTENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-452-4824
Mailing Address - Street 1:424 28TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3603
Mailing Address - Country:US
Mailing Address - Phone:510-452-4824
Mailing Address - Fax:510-465-4503
Practice Address - Street 1:424 28TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3603
Practice Address - Country:US
Practice Address - Phone:510-452-4824
Practice Address - Fax:510-465-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-27
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ70089ZMedicare UPIN