Healthcare Provider Details

I. General information

NPI: 1922205442
Provider Name (Legal Business Name): ASSOCIATED NEUROLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 HAWTHORNE AVE SUITE 203
OAKLAND CA
94609-3107
US

IV. Provider business mailing address

365 HAWTHORNE AVE SUITE 203
OAKLAND CA
94609-3107
US

V. Phone/Fax

Practice location:
  • Phone: 510-834-5778
  • Fax:
Mailing address:
  • Phone: 510-834-5778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC1233914
License Number StateCA

VIII. Authorized Official

Name: DR. RANDALL ROBERT STARKEY
Title or Position: PRESIDENT OF CORPORATION
Credential: MD
Phone: 510-834-5778