Provider Demographics
NPI:1407996093
Name:EHINGER, MARCIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:
Last Name:EHINGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARCIA
Other - Middle Name:EHINGER
Other - Last Name:VALADEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6441 SANDSTONE ST
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0950
Mailing Address - Country:US
Mailing Address - Phone:916-965-7536
Mailing Address - Fax:
Practice Address - Street 1:1515 K ST
Practice Address - Street 2:SUITE 400, MS 8100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-4051
Practice Address - Country:US
Practice Address - Phone:916-327-3012
Practice Address - Fax:916-327-1123
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36354207SG0201X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G363540Medicaid
C04210Medicare UPIN
CA00G363540Medicaid