Provider Demographics
NPI:1730125758
Name:MARIN GASTROENTEROLOGY
Entity Type:Organization
Organization Name:MARIN GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWERBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-925-6900
Mailing Address - Street 1:200 TAMAL PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1196
Mailing Address - Country:US
Mailing Address - Phone:415-925-6900
Mailing Address - Fax:415-925-6919
Practice Address - Street 1:200 TAMAL PLZ STE 200
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1196
Practice Address - Country:US
Practice Address - Phone:415-925-6900
Practice Address - Fax:415-925-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Single Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01872ZMedicare ID - Type Unspecified