Healthcare Provider Details

I. General information

NPI: 1124144902
Provider Name (Legal Business Name): MARIN GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD HOSPITALIST OFFICE
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

1679 BRODERICK ST APT 6 #6
SAN FRANCISCO CA
94115-2931
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-7545
  • Fax:
Mailing address:
  • Phone: 415-572-2192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberA82830
License Number StateCA

VIII. Authorized Official

Name: DR. KERRY DAVIDSON
Title or Position: HOSPITALIST
Credential: MD
Phone: 415-925-7545