Provider Demographics
NPI:1720179799
Name:FOSTER CITY PEDIATRIC MEDICAL GROUP INC
Entity Type:Organization
Organization Name:FOSTER CITY PEDIATRIC MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBHA
Authorized Official - Middle Name:
Authorized Official - Last Name:AAHLAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-574-2774
Mailing Address - Street 1:1295 E HILLSDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404
Mailing Address - Country:US
Mailing Address - Phone:650-574-2774
Mailing Address - Fax:650-341-9236
Practice Address - Street 1:1295 E HILLSDALE BLVD
Practice Address - Street 2:
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404
Practice Address - Country:US
Practice Address - Phone:650-574-2774
Practice Address - Fax:650-341-9236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0080460OtherMEDI-CAL
CAZZZ17671ZOtherBLUE SHIELD OF CA