Provider Demographics
NPI:1538696299
Name:STANFORD UNIVERSITY
Entity Type:Organization
Organization Name:STANFORD UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR FOR ANATOMIC & CLI
Authorized Official - Prefix:DR
Authorized Official - First Name:NEERAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMBHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-725-5193
Mailing Address - Street 1:1717 BATH RD
Mailing Address - Street 2:APT A-08
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-2747
Mailing Address - Country:US
Mailing Address - Phone:414-897-4731
Mailing Address - Fax:
Practice Address - Street 1:450 SERRA MALL
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94305-2004
Practice Address - Country:US
Practice Address - Phone:414-897-4731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty