Provider Demographics
NPI:1013060672
Name:VASCULAR ASSOCIATES OF NORTHERN CALIFORNIA
Entity Type:Organization
Organization Name:VASCULAR ASSOCIATES OF NORTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:STARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-292-7202
Mailing Address - Street 1:2512 SAMARITAN CT STE E
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4002
Mailing Address - Country:US
Mailing Address - Phone:408-358-8272
Mailing Address - Fax:
Practice Address - Street 1:2512 SAMARITAN CT STE E
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4002
Practice Address - Country:US
Practice Address - Phone:408-358-8272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0026160Medicaid
CAZZZ11627ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER