Provider Demographics
NPI:1235169541
Name:MARIN UROLOGY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:MARIN UROLOGY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEUWIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-461-4000
Mailing Address - Street 1:1000 S ELISEO DR
Mailing Address - Street 2:SUITE #201
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2133
Mailing Address - Country:US
Mailing Address - Phone:415-461-4000
Mailing Address - Fax:415-461-6907
Practice Address - Street 1:1000 S ELISEO DR
Practice Address - Street 2:SUITE #201
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2133
Practice Address - Country:US
Practice Address - Phone:415-461-4000
Practice Address - Fax:415-461-6907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26054ZMedicare ID - Type UnspecifiedMEDICARE GRP PROVIDER ID