Provider Demographics
NPI:1760562201
Name:RICHARD B. BRAUNSTEIN M.D., INC
Entity Type:Organization
Organization Name:RICHARD B. BRAUNSTEIN M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRAUNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-591-1056
Mailing Address - Street 1:1785 SAN CARLOS AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1785 SAN CARLOS AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-2055
Practice Address - Country:US
Practice Address - Phone:650-591-1056
Practice Address - Fax:650-591-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0768830001Medicare NSC
CAZZZ25401ZMedicare ID - Type Unspecified