Provider Demographics
NPI:1801994330
Name:CONTRA COSTA OBSTETRICS GYNECOLOGY & INFERTILITY MEDICAL GROUP INC
Entity type:Organization
Organization Name:CONTRA COSTA OBSTETRICS GYNECOLOGY & INFERTILITY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:ELWOOD
Authorized Official - Middle Name:LENWORTH
Authorized Official - Last Name:KRONICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-932-2565
Mailing Address - Street 1:240 LA CASA VIA
Mailing Address - Street 2:100
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-4863
Mailing Address - Country:US
Mailing Address - Phone:925-932-2565
Mailing Address - Fax:925-930-8568
Practice Address - Street 1:240 LA CASA VIA
Practice Address - Street 2:100
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-4863
Practice Address - Country:US
Practice Address - Phone:925-932-2565
Practice Address - Fax:925-930-8568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ73673ZMedicaid
ZZZ73673ZMedicare ID - Type Unspecified