Provider Demographics
NPI:1932129715
Name:GEARHART/ARAJ SURGEONS MEDICAL GROUP, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GEARHART/ARAJ SURGEONS MEDICAL GROUP, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMSEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-979-1770
Mailing Address - Street 1:1900 MOWRY AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1722
Mailing Address - Country:US
Mailing Address - Phone:510-797-1770
Mailing Address - Fax:510-797-2040
Practice Address - Street 1:1900 MOWRY AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1722
Practice Address - Country:US
Practice Address - Phone:510-797-1770
Practice Address - Fax:510-797-2040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19780ZOtherBLUE SHIELD OF CA GROUP #
CAGR0068790Medicaid
CAGR0068790Medicaid