Provider Demographics
NPI:1164514881
Name:EITAN HOMA MD AND JENNIFER KRASNOFF MD INC
Entity Type:Organization
Organization Name:EITAN HOMA MD AND JENNIFER KRASNOFF MD INC
Other - Org Name:DERMATOLOGY ASSOCIATES OF THE BAY AREA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-741-7418
Mailing Address - Street 1:500 ALFRED NOBEL DR
Mailing Address - Street 2:STE 245
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547
Mailing Address - Country:US
Mailing Address - Phone:510-741-7418
Mailing Address - Fax:510-741-7456
Practice Address - Street 1:500 ALFRED NOBEL DR
Practice Address - Street 2:STE 245
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547
Practice Address - Country:US
Practice Address - Phone:510-741-7418
Practice Address - Fax:510-741-7456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ00647ZOtherBLUE SHILED
CAC14303OtherRAILROAD MEDICARE
CAZZZ01660ZMedicare PIN