Provider Demographics
NPI:1851426266
Name:MAGNUSON, JOSEPHINE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:ANNE
Last Name:MAGNUSON
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 1:2204 GRANT ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3877
Mailing Address - Country:US
Mailing Address - Phone:650-428-1200
Mailing Address - Fax:650-428-1202
Practice Address - Street 1:2204 GRANT ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3877
Practice Address - Country:US
Practice Address - Phone:650-428-1200
Practice Address - Fax:650-428-1202
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42554207R00000X
CAG042554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G425540Medicare ID - Type Unspecified
A49016Medicare UPIN