Healthcare Provider Details

I. General information

NPI: 1184648636
Provider Name (Legal Business Name): SHELLEY R. MARDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 OFARRELL ST
SAN FRANCISCO CA
94115-3357
US

IV. Provider business mailing address

65 DORANTES AVE
SAN FRANCISCO CA
94116-1430
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-2000
  • Fax: 415-353-8570
Mailing address:
  • Phone: 415-833-6012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG46906
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberG46906
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG46906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: