Provider Demographics
NPI:1972655090
Name:NYE, ANN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:MARIE
Last Name:NYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:MILIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:577 AIRPORT BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-2020
Mailing Address - Country:US
Mailing Address - Phone:650-240-8198
Mailing Address - Fax:408-328-5695
Practice Address - Street 1:100 S SAN MATEO DR
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3805
Practice Address - Country:US
Practice Address - Phone:650-696-4427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H62358Medicare UPIN