Healthcare Provider Details

I. General information

NPI: 1174675417
Provider Name (Legal Business Name): WASHINGTON TOWNSHIP MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38690 STIVERS ST SUITE A
FREMONT CA
94536-5279
US

IV. Provider business mailing address

39141 CIVIC CENTER DR SUITE 220
FREMONT CA
94538-5818
US

V. Phone/Fax

Practice location:
  • Phone: 510-248-1040
  • Fax: 510-797-7426
Mailing address:
  • Phone: 510-248-1000
  • Fax: 510-608-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG36600
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG36600
License Number StateCA

VIII. Authorized Official

Name: DR. ALBERT L BROOKS
Title or Position: PRESIDENT
Credential: MD
Phone: 510-248-1000