Provider Demographics
NPI:1376548156
Name:HONEGGER, MARILYN MASTEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:MASTEN
Last Name:HONEGGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CAMINO ENCINAS
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3309
Mailing Address - Country:US
Mailing Address - Phone:510-204-8180
Mailing Address - Fax:925-254-0687
Practice Address - Street 1:12 CAMINO ENCINAS
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3309
Practice Address - Country:US
Practice Address - Phone:510-204-8180
Practice Address - Fax:925-254-0687
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53701207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD28289Medicare UPIN
CA00G537010Medicare ID - Type UnspecifiedPPIN