Provider Demographics
NPI:1639124357
Name:ALPERT, MARJORIE D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:D
Last Name:ALPERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2191 MOWRY AVE
Mailing Address - Street 2:SUITE 600 C
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-792-4373
Mailing Address - Fax:510-792-3420
Practice Address - Street 1:2191 MOWRY AVE
Practice Address - Street 2:SUITE 600 C
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-792-4373
Practice Address - Fax:510-792-3420
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA055094208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A550940Medicaid
G66191Medicare UPIN