Provider Demographics
NPI:1619019312
Name:SYDORAK, GERALD (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:SYDORAK
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 1:1828 EL CAMINO REAL
Mailing Address - Street 2:SUITE 611
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3120
Mailing Address - Country:US
Mailing Address - Phone:650-697-7003
Mailing Address - Fax:650-697-7065
Practice Address - Street 1:1800 SULLIVAN AVE RM 507
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2225
Practice Address - Country:US
Practice Address - Phone:650-697-7003
Practice Address - Fax:650-697-7065
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG17750208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG017750OtherLICENSE
CAYYY34803YMedicaid
CAA40184Medicare UPIN
CAYYY34803YMedicaid