Healthcare Provider Details

I. General information

NPI: 1891741047
Provider Name (Legal Business Name): BAY AREA PULMONARY MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 30TH ST STE. 520
OAKLAND CA
94609-3424
US

IV. Provider business mailing address

350 30TH ST STE. 520
OAKLAND CA
94609-3424
US

V. Phone/Fax

Practice location:
  • Phone: 510-465-6800
  • Fax: 510-268-0634
Mailing address:
  • Phone: 510-465-6800
  • Fax: 510-268-0634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG29266
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG30025
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberH57130
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA71504
License Number StateCA

VIII. Authorized Official

Name: DR. FREDRIC NEAL HERSKOWITZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 510-465-6800