Provider Demographics
NPI:1740286079
Name:MCGRAEL-SOUDERS, ADRIENNE LAURA (MD)
Entity type:Individual
Prefix:PROF
First Name:ADRIENNE
Middle Name:LAURA
Last Name:MCGRAEL-SOUDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-204-8130
Mailing Address - Fax:510-524-0861
Practice Address - Street 1:500 SAN PABLO AVE STE 300
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1103
Practice Address - Country:US
Practice Address - Phone:510-204-8130
Practice Address - Fax:510-524-0861
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2019-10-03
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
CA295111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG48839OtherSTATE MEDICAL LICENSE