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General NPI Number Information
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NPI Number | 1922205442
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Entity Type | Organization
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Legal Business Name | ASSOCIATED NEUROLOGY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 365 HAWTHORNE AVE SUITE 203
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City | OAKLAND
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State | CA
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Zip | 94609-3107
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Country | US
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Telephone | 510-834-5778
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Fax |
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Provider Business Mailing Address
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Address Line | 365 HAWTHORNE AVE SUITE 203
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City | OAKLAND
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State | CA
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Zip | 94609-3107
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Country | US
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Telephone | 510-834-5778
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Fax |
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Authorized Official
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Title or Position | PRESIDENT OF CORPORATION
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Name | DR. RANDALL ROBERT STARKEY
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Credential | MD
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Telephone | 510-834-5778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | C1233914
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License Number State | CA
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