Provider Demographics
NPI:1346285996
Name:MCGLOTHLIN, DANA P (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:P
Last Name:MCGLOTHLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:PRUITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1635 DIVISADERO ST
Mailing Address - Street 2:SUITE 625, BOX 1821
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3036
Mailing Address - Country:US
Mailing Address - Phone:415-476-4029
Mailing Address - Fax:415-476-4150
Practice Address - Street 1:350 PARNASSUS AVE STE 204
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-3608
Practice Address - Country:US
Practice Address - Phone:415-353-2873
Practice Address - Fax:415-353-4339
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79218207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A792180Medicaid
CA00A792180Medicaid
CA00A792180Medicare PIN