Healthcare Provider Details

I. General information

NPI: 1114090396
Provider Name (Legal Business Name): JANE MARTEN MEILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE MARTEN MD

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SOUTH ELISEO DR STE #106
GREENBRAE CA
94904
US

IV. Provider business mailing address

1100 SOUTH ELISEO DR STE #106
GREENBRAE CA
94904
US

V. Phone/Fax

Practice location:
  • Phone: 415-461-8828
  • Fax: 415-461-3772
Mailing address:
  • Phone: 415-461-8828
  • Fax: 415-461-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG59472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: