Provider Demographics
NPI:1083825947
Name:DERMATOLOGY CONSULTANTS OF SACRAMENTO A MEDICAL CORP
Entity Type:Organization
Organization Name:DERMATOLOGY CONSULTANTS OF SACRAMENTO A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-739-1505
Mailing Address - Street 1:5340 ELVAS AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-2345
Mailing Address - Country:US
Mailing Address - Phone:916-739-1505
Mailing Address - Fax:916-739-1426
Practice Address - Street 1:5340 ELVAS AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-2345
Practice Address - Country:US
Practice Address - Phone:916-739-1505
Practice Address - Fax:916-739-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34793207NS0135X
CAG36407207NS0135X
CAA55877207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1518043777OtherNPI- LAYNE HERSH MD
CA1447340849OtherNPI - LAWRENCE J. BASS MD
CA1609952860OtherNPI- MARGARET PARSONS MD
CA1447340849OtherNPI - LAWRENCE J. BASS MD
CAA35730Medicare UPIN
CAA46675Medicare UPIN
CAA35730Medicare ID - Type UnspecifiedLAWRENCE J BASS MD
CA1609952860OtherNPI- MARGARET PARSONS MD
CAA46675Medicare ID - Type UnspecifiedDR LAYNE HERSH