Provider Demographics
NPI:1508861071
Name:CONTRA COSTA CARDIOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:CONTRA COSTA CARDIOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MCWHIRTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-671-0610
Mailing Address - Street 1:2485 HIGH SCHOOL STREET
Mailing Address - Street 2:STE 100
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-1816
Mailing Address - Country:US
Mailing Address - Phone:925-671-0610
Mailing Address - Fax:925-671-0878
Practice Address - Street 1:2485 HIGH SCHOOL AVE
Practice Address - Street 2:STE 100
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1819
Practice Address - Country:US
Practice Address - Phone:925-671-0610
Practice Address - Fax:925-671-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0009370Medicaid
CAZZZ29404ZMedicare ID - Type UnspecifiedPROVIDER NUMBER
CAGR0009370Medicaid
CAA72418Medicare UPIN
CAA21387Medicare UPIN
CAA26017Medicare UPIN
CAA45577Medicare UPIN