Provider Demographics
NPI:1457371643
Name:MATHIAS MASEM, M.D.
Entity Type:Organization
Organization Name:MATHIAS MASEM, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PRACTIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MASEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-763-0709
Mailing Address - Street 1:80 GRAND AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3744
Mailing Address - Country:US
Mailing Address - Phone:510-763-0709
Mailing Address - Fax:510-763-8753
Practice Address - Street 1:80 GRAND AVE.,
Practice Address - Street 2:SUITE 600
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612
Practice Address - Country:US
Practice Address - Phone:510-763-0709
Practice Address - Fax:510-763-8753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34134174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G341340Medicare ID - Type UnspecifiedMATHIAS MASEM, M.D.