Provider Demographics
NPI:1134107378
Name:GERSHBEIN, BART (MD)
Entity Type:Individual
Prefix:DR
First Name:BART
Middle Name:
Last Name:GERSHBEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1300 S ELISEO DRIVE
Mailing Address - Street 2:#104
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904
Mailing Address - Country:US
Mailing Address - Phone:415-464-9988
Mailing Address - Fax:415-464-9987
Practice Address - Street 1:1300 S ELISEO DRIVE
Practice Address - Street 2:#104
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904
Practice Address - Country:US
Practice Address - Phone:415-464-9988
Practice Address - Fax:415-464-9987
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00G300310208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG300310Medicaid
A89492Medicare UPIN
CAOOG300310Medicaid