Provider Demographics
NPI:1578604211
Name:ALAMEDA FAMILY PHYSICIAN MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:ALAMEDA FAMILY PHYSICIAN MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO- OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:CANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-521-2300
Mailing Address - Street 1:2433 CENTRAL AVE
Mailing Address - Street 2:2433 CENTRAL AVENUE
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6562
Mailing Address - Country:US
Mailing Address - Phone:510-521-2300
Mailing Address - Fax:
Practice Address - Street 1:2433 CENTRAL AVE
Practice Address - Street 2:2433 CENTRAL AVENUE
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-6562
Practice Address - Country:US
Practice Address - Phone:510-521-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0045200Medicaid
CAZZZ11561ZMedicare ID - Type UnspecifiedMEDICARE