Provider Demographics
NPI:1114900396
Name:BAY AREA CARDIOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:BAY AREA CARDIOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOSNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-294-9037
Mailing Address - Street 1:1133 E STANLEY BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4200
Mailing Address - Country:US
Mailing Address - Phone:925-294-9037
Mailing Address - Fax:925-294-9272
Practice Address - Street 1:1133 E STANLEY BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4200
Practice Address - Country:US
Practice Address - Phone:925-294-9037
Practice Address - Fax:925-294-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0040841Medicaid
CAGR0040841Medicaid