Provider Demographics
NPI:1891930673
Name:EAST BAY RHEUMATOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:EAST BAY RHEUMATOLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NEUWELT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-357-1303
Mailing Address - Street 1:13851 E 14TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2630
Mailing Address - Country:US
Mailing Address - Phone:510-357-1303
Mailing Address - Fax:510-357-5463
Practice Address - Street 1:13851 E 14TH ST STE 301
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2630
Practice Address - Country:US
Practice Address - Phone:510-357-1303
Practice Address - Fax:510-357-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38264174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty