Provider Demographics
NPI:1518033513
Name:UROLOGICAL ASSOC MEDICAL GRP INC
Entity Type:Organization
Organization Name:UROLOGICAL ASSOC MEDICAL GRP INC
Other - Org Name:LEONARD A BRANT MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-609-8513
Mailing Address - Street 1:3637 CALIFORNIA STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118
Mailing Address - Country:US
Mailing Address - Phone:415-752-7100
Mailing Address - Fax:415-752-1451
Practice Address - Street 1:3637 CALIFORNIA STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118
Practice Address - Country:US
Practice Address - Phone:415-752-7100
Practice Address - Fax:415-752-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208800000X
CAA28777261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1518033513OtherNPI FOR UROLOGICAL ASSOC MEDICAL GRP
CA1013106517OtherNPI FOR LEONARD A BRANT MD
CA1013106517OtherNPI FOR LEONARD A BRANT MD
CAZZZ99377ZMedicare PIN