Provider Demographics
NPI:1750589560
Name:DONALD R. KNOTTS, M.D. INC
Entity type:Organization
Organization Name:DONALD R. KNOTTS, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:KNOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-886-3701
Mailing Address - Street 1:20130 LAKE CHABOT RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5340
Mailing Address - Country:US
Mailing Address - Phone:510-886-3701
Mailing Address - Fax:510-537-3194
Practice Address - Street 1:20130 LAKE CHABOT RD
Practice Address - Street 2:SUITE 309
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5340
Practice Address - Country:US
Practice Address - Phone:510-886-3701
Practice Address - Fax:510-537-3194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35548261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46397Medicare UPIN