Provider Demographics
NPI:1851346977
Name:QOUBAITARY, AMMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:AMMAR
Middle Name:
Last Name:QOUBAITARY
Suffix:
Gender:M
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:DEPT 34929
Mailing Address - Street 2:P.O. BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:2305 CAMINO RAMON
Practice Address - Street 2:SUITE 270
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1396
Practice Address - Country:US
Practice Address - Phone:925-866-8700
Practice Address - Fax:925-866-8701
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83625207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A836250Medicaid
CAP01173251OtherRAILROAD MEDICARE
CA00A836250Medicaid