Healthcare Provider Details

I. General information

NPI: 1548829872
Provider Name (Legal Business Name): PAI PARTICIPANT 7 PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 GARFIELD AVE
CARMICHAEL CA
95608-6647
US

IV. Provider business mailing address

PO BOX 639676
CINCINNATI OH
45263-9676
US

V. Phone/Fax

Practice location:
  • Phone: 916-481-6489
  • Fax:
Mailing address:
  • Phone: 859-291-4800
  • Fax: 859-655-8588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIN N LAIRD
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 410-458-8713