Provider Demographics
NPI:1851403521
Name:AFFILIATES IN DERMATOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:AFFILIATES IN DERMATOLOGY MEDICAL GROUP, INC.
Other - Org Name:AFFILIATES IN DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PASLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-652-2926
Mailing Address - Street 1:460 34TH STREET
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-652-8091
Mailing Address - Fax:510-652-5156
Practice Address - Street 1:460 34TH STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-652-8091
Practice Address - Fax:510-652-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ77674ZMedicare UPIN
CAZZZ77674ZMedicare UPIN