Healthcare Provider Details

I. General information

NPI: 1568968402
Provider Name (Legal Business Name): GILBERT TETTEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2018
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W MACARTHUR BLVD
OAKLAND CA
94611-5641
US

IV. Provider business mailing address

690 LONG BRIDGE ST APT 1503
SAN FRANCISCO CA
94158-2423
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-1000
  • Fax: 718-470-9113
Mailing address:
  • Phone: 917-300-1494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number310441
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: