Healthcare Provider Details

I. General information

NPI: 1336184589
Provider Name (Legal Business Name): ALBERT M MARLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15215 NATIONAL AVE STE 200
LOS GATOS CA
95032-2425
US

IV. Provider business mailing address

15215 NATIONAL AVE STE 200
LOS GATOS CA
95032-2425
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-1841
  • Fax: 408-358-3562
Mailing address:
  • Phone: 408-358-1841
  • Fax: 408-358-3562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG35956
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG35956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: