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Contact Information

GREENBRAE DERMATOLOGY, A MEDICAL CORPORATION
1300 S ELISEO DR STE 207
GREENBRAE, CA94904-2015
 Phone: 415-925-0550
 Fax: 415-925-9062
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
 

Dermatopathology

207ND0900X 07 Physician/Dermatology
 

MOHS-Micrographic Surgery

207ND0101X 07 Physician/Dermatology
 

Pediatric Dermatology

207NP0225X 07 Physician/Dermatology
 

Procedural Dermatology

207NS0135X 07 Physician/Dermatology
Indicates primary specialty

NPI Profile & details for GREENBRAE DERMATOLOGY, A MEDICAL CORPORATION

NPI Number 1174898654
LBN Legal business name GREENBRAE DERMATOLOGY, A MEDICAL CORPORATION
Authorized official LUCRETIA LEWITT - (PRACTICE MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 03/15/2012
Last updated 06/30/2015 - About 11 years ago
Identifiers
CA License # A97783
CA License # G40606
CA License # G53455
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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