Provider Demographics
NPI:1932585874
Name:BAY AREA MEDICAL GROUP INC
Entity Type:Organization
Organization Name:BAY AREA MEDICAL GROUP INC
Other - Org Name:BAY AREA MEDICAL GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CARDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRIAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIDARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-761-4671
Mailing Address - Street 1:105 N BASCOM AVE
Mailing Address - Street 2:204
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1811
Mailing Address - Country:US
Mailing Address - Phone:408-918-0400
Mailing Address - Fax:408-286-2922
Practice Address - Street 1:105 N BASCOM AVE
Practice Address - Street 2:204
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1811
Practice Address - Country:US
Practice Address - Phone:408-918-0400
Practice Address - Fax:408-286-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82213207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty