Healthcare Provider Details

I. General information

NPI: 1144849027
Provider Name (Legal Business Name): EMILY RIDER-LONGMAID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 DIVISADERO ST
SAN FRANCISCO CA
94143-3400
US

IV. Provider business mailing address

1545 DIVISADERO ST # 1
SAN FRANCISCO CA
94143-3400
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7900
  • Fax: 415-353-2405
Mailing address:
  • Phone: 415-353-7900
  • Fax: 415-353-2405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA204983
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberMT221460
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT221460
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: