Provider Demographics
NPI:1457654394
Name:PRAVDIN MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PRAVDIN MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRAVDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-701-1882
Mailing Address - Street 1:570 PRICE AVE
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1433
Mailing Address - Country:US
Mailing Address - Phone:650-327-1258
Mailing Address - Fax:855-200-0915
Practice Address - Street 1:570 PRICE AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1433
Practice Address - Country:US
Practice Address - Phone:650-701-1882
Practice Address - Fax:650-701-1886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty