Provider Demographics
NPI:1568577997
Name:BAY AREA PEDIATRIC PULMONARY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:BAY AREA PEDIATRIC PULMONARY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-428-3885
Mailing Address - Street 1:747 52ND ST
Mailing Address - Street 2:SUITE 5409
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1809
Mailing Address - Country:US
Mailing Address - Phone:510-428-3305
Mailing Address - Fax:510-597-7154
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:SUITE 5409
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3305
Practice Address - Fax:510-597-7154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64422ZOtherBLUE SHIELD PROVIDER NUMB
CAGR0085560Medicaid
CAZZZ60449ZOtherBLUE SHIELD PROVIDER NUMB
CAZZZ60448ZOtherBLUE SHIELD PROVIDER NUMB
CAGR0085561Medicaid