MEDICARE: DR. CLEMENS ESCHE M.D.

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	207N00000X	Dermatology Physician	C163030	CA
2	207N00000X	Dermatology Physician	MD448189	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00752410	OTHER		RAILROAD

General Provider Information

NPI Number	:	1790826394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLEMENS ESCHE M.D.

Provider Business Mailing Address
First Line	:	370 N WIGET LN STE 250
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-2454
Country	:	US
Telephone Number	:	925-945-7005
Fax Number	:	925-954-1822

Provider Business Practice Location Address
First Line	:	5575 W LAS POSITAS BLVD STE 260
Second Line	:
City	:	PLEASANTON
State	:	CA
Zip	:	94588-5803
Country	:	US
Telephone Number	:	925-847-3020
Fax Number	:	925-954-1822

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	06/07/2022

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