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General NPI Number Information
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NPI Number | 1629386867
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Entity Type | Organization
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Legal Business Name | MARK BAZALGETTE, M.D., INC.
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 1300 S ELISEO DR SUITE 203
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City | GREENBRAE
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State | CA
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Zip | 94904-2023
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Country | US
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Telephone | 415-461-3300
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Fax | 415-461-2934
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Provider Business Mailing Address
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Address Line | 1300 S ELISEO DR SUITE 203
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City | GREENBRAE
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State | CA
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Zip | 94904-2023
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Country | US
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Telephone | 415-461-3300
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Fax | 415-461-2934
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. KIMBERLY PARDINI
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Credential |
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Telephone | 415-461-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | A46290
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License Number State | CA
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