Provider Demographics
NPI:1710934054
Name:NEW DANVILLE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:NEW DANVILLE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:UMESH
Authorized Official - Middle Name:HANASRAG
Authorized Official - Last Name:GHEEWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-837-4202
Mailing Address - Street 1:907 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:SUITE #202
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-4036
Mailing Address - Country:US
Mailing Address - Phone:925-837-4202
Mailing Address - Fax:925-838-3224
Practice Address - Street 1:907 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE #202
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-4036
Practice Address - Country:US
Practice Address - Phone:925-837-4202
Practice Address - Fax:925-838-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982608568OtherUU. GHEEWALA MD NPI#
CA1982608576OtherNPI # S MANN PA-C
AR1124022710OtherJ. SIINO, MD NPI #
CAA28595Medicare UPIN
CAZZZ14325ZMedicare ID - Type UnspecifiedGROUP MEDICARE PROV NUMB
CA1982608568OtherUU. GHEEWALA MD NPI#
CA1982608576OtherNPI # S MANN PA-C