Provider Demographics
NPI:1467560094
Name:WASSERSTEIN, PAUL WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WILLIAM
Last Name:WASSERSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1615 HILL RD
Mailing Address - Street 2:STE B
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947
Mailing Address - Country:US
Mailing Address - Phone:415-898-7649
Mailing Address - Fax:415-898-0870
Practice Address - Street 1:250 BON AIR RD
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904
Practice Address - Country:US
Practice Address - Phone:415-925-7174
Practice Address - Fax:415-898-0870
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG358910207U00000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G358910Medicaid
A46514Medicare UPIN
CACA00G358910Medicare ID - Type Unspecified