Provider Demographics
NPI:1619003282
Name:GLADSTONE, HAYES BORDMAN (MD)
Entity Type:Individual
Prefix:
First Name:HAYES
Middle Name:BORDMAN
Last Name:GLADSTONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3860 BLACKHAWK RD STE 140
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4832
Mailing Address - Country:US
Mailing Address - Phone:925-837-6000
Mailing Address - Fax:925-837-6011
Practice Address - Street 1:3860 BLACKHAWK RD STE 140
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4832
Practice Address - Country:US
Practice Address - Phone:925-837-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52367207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A523670Medicaid
CA00A523670Medicaid
CA00A523670Medicare ID - Type Unspecified