Provider Demographics
NPI:1346225430
Name:SEID, DERICE PATRICIA (ME)
Entity Type:Individual
Prefix:
First Name:DERICE
Middle Name:PATRICIA
Last Name:SEID
Suffix:
Gender:F
Credentials:ME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 HAYES ST
Mailing Address - Street 2:#500
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1013
Mailing Address - Country:US
Mailing Address - Phone:415-221-1901
Mailing Address - Fax:
Practice Address - Street 1:2250 HAYES ST
Practice Address - Street 2:STE 500
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1013
Practice Address - Country:US
Practice Address - Phone:415-221-1901
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061472207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A061472Medicare ID - Type Unspecified
H09452Medicare UPIN