Provider Demographics
NPI:1891741047
Name:BAY AREA PULMONARY MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:BAY AREA PULMONARY MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRIC
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:HERSKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-465-6800
Mailing Address - Street 1:350 30TH ST
Mailing Address - Street 2:STE. 520
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3424
Mailing Address - Country:US
Mailing Address - Phone:510-465-6800
Mailing Address - Fax:510-268-0634
Practice Address - Street 1:350 30TH ST
Practice Address - Street 2:STE. 520
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3424
Practice Address - Country:US
Practice Address - Phone:510-465-6800
Practice Address - Fax:510-268-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30025207RC0200X
CAH57130207RC0200X
CAG29266207RP1001X
CAA71504207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ78879ZMedicaid
CAZZZ78879ZMedicaid