Provider Demographics
NPI:1265161368
Name:WALNUT CREEK DERMATOLOGY
Entity type:Organization
Organization Name:WALNUT CREEK DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:RADELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-391-9439
Mailing Address - Street 1:3147 PUTNAM BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4686
Mailing Address - Country:US
Mailing Address - Phone:925-391-9439
Mailing Address - Fax:
Practice Address - Street 1:3147 PUTNAM BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4686
Practice Address - Country:US
Practice Address - Phone:925-391-9439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty