Provider Demographics
NPI:1659445344
Name:EAST OAKLAND PEDIATRICS INC
Entity Type:Organization
Organization Name:EAST OAKLAND PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GLANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-532-0918
Mailing Address - Street 1:5461 FOOTHILL BLVD
Mailing Address - Street 2:EAST OAKLAND PEDIATRICS INC
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601
Mailing Address - Country:US
Mailing Address - Phone:510-532-0918
Mailing Address - Fax:510-532-0956
Practice Address - Street 1:5461 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601
Practice Address - Country:US
Practice Address - Phone:510-532-0918
Practice Address - Fax:510-532-0956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty