MEDICARE: EAST BAY PERINATAL MEDICAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VM0101X	Maternal & Fetal Medicine Physician	A40757	CA

General Provider Information

NPI Number	:	1144272170
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST BAY PERINATAL MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	5528 PACHECO BLVD
Second Line	:	SUITE A
City	:	PACHECO
State	:	CA
Zip	:	94553-5154
Country	:	US
Telephone Number	:	925-232-8170
Fax Number	:	925-636-4995

Provider Business Practice Location Address
First Line	:	350 30TH ST
Second Line	:	SUITE 208
City	:	OAKLAND
State	:	CA
Zip	:	94609-3425
Country	:	US
Telephone Number	:	510-444-0790
Fax Number	:	510-869-6225

Authorized Official
Title or Position	:	PERINATOLOGIST
Name	:	DR. STUART MITCHELL LOVETT
Credential	:	M.D., F.A.C.O.G.
Telephone Number	:	510-444-0790

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	02/15/2011

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