MEDICARE: BAY AREA PEDIATRIC MEDICAL GROUP INC

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		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	:	1619142544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA PEDIATRIC MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	1500 SOUTHGATE AVE STE 104
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94015-2205
Country	:	US
Telephone Number	:	650-992-4200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 SOUTHGATE AVE STE 213
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94015-2231
Country	:	US
Telephone Number	:	650-994-1800
Fax Number	:	650-994-1888

Authorized Official
Title or Position	:	MANAGER BUSINESS OFFICE
Name	:	DONNA OCONNELL
Credential	:
Telephone Number	:	650-994-1800

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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