Provider Demographics
NPI:1982838504
Name:DERMATOLOGY MEDICAL GROUP OF SF
Entity Type:Organization
Organization Name:DERMATOLOGY MEDICAL GROUP OF SF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-362-2238
Mailing Address - Street 1:490 POST ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1401
Mailing Address - Country:US
Mailing Address - Phone:415-362-2238
Mailing Address - Fax:415-362-7745
Practice Address - Street 1:490 POST ST
Practice Address - Street 2:SUITE 700
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1401
Practice Address - Country:US
Practice Address - Phone:415-362-2238
Practice Address - Fax:415-362-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ14910ZMedicare PIN