Provider Demographics
NPI:1639382070
Name:SANTA ROSA OB-GYN MEDICAL ASSOCIATES GROUP
Entity Type:Organization
Organization Name:SANTA ROSA OB-GYN MEDICAL ASSOCIATES GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-545-9536
Mailing Address - Street 1:500 DOYLE PARK DR STE G04
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4559
Mailing Address - Country:US
Mailing Address - Phone:707-545-9536
Mailing Address - Fax:707-545-1802
Practice Address - Street 1:500 DOYLE PARK DR STE G04
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4559
Practice Address - Country:US
Practice Address - Phone:707-545-9536
Practice Address - Fax:707-545-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty