Provider Demographics
NPI:1457457608
Name:INTERNAL MEDICINE ASSOCIATES OF BERKELEY, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF BERKELEY, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-843-8002
Mailing Address - Street 1:PO BOX 1440
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-4440
Mailing Address - Country:US
Mailing Address - Phone:415-493-3300
Mailing Address - Fax:415-493-3301
Practice Address - Street 1:2320 WOOLSEY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1973
Practice Address - Country:US
Practice Address - Phone:510-843-8002
Practice Address - Fax:510-540-4808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ27095Z207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0103300OtherMEDICAL
CAZZZ27095ZMedicare PIN