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General NPI Number Information
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NPI Number | 1235169541
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Entity Type | Organization
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Legal Business Name | MARIN UROLOGY MEDICAL GROUP, INC
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 02/12/2010
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Provider Practice Location Address
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Address Line | 1000 S ELISEO DR SUITE #201
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City | GREENBRAE
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State | CA
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Zip | 94904-2133
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Country | US
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Telephone | 415-461-4000
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Fax | 415-461-6907
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Provider Business Mailing Address
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Address Line | 1000 S ELISEO DR SUITE #201
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City | GREENBRAE
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State | CA
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Zip | 94904-2133
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Country | US
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Telephone | 415-461-4000
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Fax | 415-461-6907
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HARRY NEUWIRTH
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Credential | M.D.
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Telephone | 415-461-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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