MEDICARE: ALBERT L. PISANI MD A MEDICAL CORP

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	174400000X	Specialist	G067056	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W18764	OTHER	CA	MEDICARE GROUP

General Provider Information

NPI Number	:	1881872117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBERT L. PISANI MD A MEDICAL CORP

Provider Business Mailing Address
First Line	:	3519 ALTAMONT WAY
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062-3105
Country	:	US
Telephone Number	:	650-722-8636
Fax Number	:

Provider Business Practice Location Address
First Line	:	3519 ALTAMONT WAY
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062-3105
Country	:	US
Telephone Number	:	650-722-8636
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALBERT L PISANI
Credential	:	MD
Telephone Number	:	650-722-8636

Provider Enumeration Date	:	02/08/2008
Last Update Date	:	02/08/2008

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