Healthcare Provider Details

I. General information

NPI: 1023041753
Provider Name (Legal Business Name): MARIN HOSPITALIST MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD 3RD FLOOR
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

336 BON AIR CENTER #427
GREENBRAE CA
94904
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-7545
  • Fax: 415-925-7008
Mailing address:
  • Phone: 415-925-7545
  • Fax: 415-925-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG73589
License Number StateCA

VIII. Authorized Official

Name: MR. DOUGLAS COHEN
Title or Position: CEO
Credential: MD
Phone: 415-518-8115