Healthcare Provider Details

I. General information

NPI: 1013271162
Provider Name (Legal Business Name): MARC S USATIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 BRIDGE RD
WALNUT CREEK CA
94595-1325
US

IV. Provider business mailing address

440 BRIDGE RD
WALNUT CREEK CA
94595-1325
US

V. Phone/Fax

Practice location:
  • Phone: 925-209-0100
  • Fax:
Mailing address:
  • Phone: 925-209-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG32932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: