Provider Demographics
NPI:1376947978
Name:HAYES B. GLADSTONE, MD, PC.
Entity Type:Organization
Organization Name:HAYES B. GLADSTONE, MD, PC.
Other - Org Name:GLADSTONE CLINIC FOR SKIN CANCER, LASERS, AESTHETIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYES
Authorized Official - Middle Name:B
Authorized Official - Last Name:GLADSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-837-6000
Mailing Address - Street 1:3860 BLACKHAWK RD STE 140
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4832
Mailing Address - Country:US
Mailing Address - Phone:925-837-6000
Mailing Address - Fax:925-837-6011
Practice Address - Street 1:3860 BLACKHAWK RD STE 140
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4832
Practice Address - Country:US
Practice Address - Phone:925-837-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-10
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207N00000X, 207ND0101X
CAA52367207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA135281Medicare PIN