Provider Demographics
NPI:1710411939
Name:FAHDEN, NORA STILLMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NORA
Middle Name:STILLMAN
Last Name:FAHDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NORA
Other - Middle Name:KATHLEEN
Other - Last Name:STILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5601 NORRIS CANYON RD STE 230
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5407
Mailing Address - Country:US
Mailing Address - Phone:925-277-7550
Mailing Address - Fax:
Practice Address - Street 1:5601 NORRIS CANYON RD STE 230
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5407
Practice Address - Country:US
Practice Address - Phone:925-277-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA157334208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics