=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699851402
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BAY AREA UROLOGY MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 10/29/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 S SAN MATEO DR SUITE 120
-----------------------------------------------------
City | SAN MATEO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94401-3857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-348-7770
-----------------------------------------------------
Fax | 650-348-0166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 S SAN MATEO DR SUITE 120
-----------------------------------------------------
City | SAN MATEO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94401-3857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-348-7770
-----------------------------------------------------
Fax | 650-348-0166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID J CARO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 650-348-7770
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------