Provider Demographics
NPI:1457326852
Name:GRINBERG, GARY G (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:G
Last Name:GRINBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HARRISON ST 7TH FL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3466
Mailing Address - Country:US
Mailing Address - Phone:510-625-2856
Mailing Address - Fax:877-738-4262
Practice Address - Street 1:800 HOWE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3911
Practice Address - Country:US
Practice Address - Phone:916-568-5551
Practice Address - Fax:916-568-5575
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100593208600000X
MN45723208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN567430100Medicaid
CAA100593OtherCA STATE LICENSE
H92877Medicare UPIN
CAA100593OtherCA STATE LICENSE
MNP00054241Medicare ID - Type UnspecifiedRAILROAD