Healthcare Provider Details

I. General information

NPI: 1053300798
Provider Name (Legal Business Name): ARUP ROY-BURMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2005
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE M680
SAN FRANCISCO CA
94143-0106
US

IV. Provider business mailing address

505 PARNASSUS AVE M680
SAN FRANCISCO CA
94143-0106
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-5153
  • Fax: 415-502-4186
Mailing address:
  • Phone: 415-476-5153
  • Fax: 415-502-4186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA54828
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: