Provider Demographics
NPI:1013020833
Name:BERZANSKY, MARC B (DO)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:B
Last Name:BERZANSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:911 MORAGA RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4579
Mailing Address - Country:US
Mailing Address - Phone:925-962-9120
Mailing Address - Fax:510-654-2464
Practice Address - Street 1:911 MORAGA RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4579
Practice Address - Country:US
Practice Address - Phone:925-961-9120
Practice Address - Fax:510-654-2464
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A8064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000810568292OtherPHCS
CA00AX80640Medicaid
CA2315376OtherUNITED
CA020A80640OtherBLUE SHIELD
CA100564OtherHEALTH NET
CA8814849OtherCIGNA
CAMCMG253600OtherWESTERN HEALTH ADVANTAGE
CA20A8064OtherBLUE CROSS
CA7613455OtherAETNA
CA2110598OtherFIRST HEALTH
CA81949OtherINTERPLAN
CA1664061OtherGREAT WEST
CA90134403OtherPACIFICARE
CA7613455OtherAETNA
CA000810568292OtherPHCS