MEDICARE: AMY M. MAIDENBERG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD00040212	WA
2	208000000X	Pediatrics Physician	A98623	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265420244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY M. MAIDENBERG MD

Provider Business Mailing Address
First Line	:	PO BOX 618
Second Line	:
City	:	NOVATO
State	:	CA
Zip	:	94948-0618
Country	:	US
Telephone Number	:	510-433-1040
Fax Number	:	510-864-1934

Provider Business Practice Location Address
First Line	:	4329 PIEDMONT AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-4715
Country	:	US
Telephone Number	:	510-418-9331
Fax Number	:	888-844-4383

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	01/26/2022

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