EAST BAY GASTROENTEROLOGY MEDICAL GROUP, INC. (NPI# 1881734515) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881734515 |
| Entity Type | Organization |
| Organization Name | EAST BAY GASTROENTEROLOGY MEDICAL GROUP, INC. |
| Practice Address |
350 30th St Suite 305 Oakland CA 94609-3424 |
| Practice Telephone | 5108322767 |
| Practice Fax Number | 5108326713 |
| Mailing Telephone | 5108322767 |
| Mailing Fax Number | 5108326713 |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. HARVEY W OLSEN (PRESIDENT) |
| Authorized Official Telephone | 5108322767 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0100X |
Internal Medicine Specialization: Gastroenterology |
Allopathic & Osteopathic Physicians |
| Street Address |
350 30TH ST SUITE 305 |
| City | OAKLAND |
| State | CA |
| Zip Code | 94609-3424 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932183472 | Yi Yi Stephanie Gu | Internal Medicine | 350 30th St, #320, Oakland, CA 94609-3424 | 2005-11-29 |
| 1225561095 | Jonathan R Dunham | Physician Assistant | 350 30th St, Suite 530, Oakland, CA 94609-3424 | 2017-04-07 |
| 1609317015 | Baychildren's Physicians | Obstetrics & Gynecology | 350 30th St, Suite 208, Oakland, CA 94609-3424 | 2017-03-17 |
| 1417320896 | Sarah Holmgren | Nurse Practitioner | 350 30th St, Suite 320, Oakland, CA 94609-3424 | 2015-11-05 |
| 1477975860 | Hiva Kolodrubetz | Registered Nurse | 350 30th St, #320, Oakland, CA 94609-3424 | 2014-01-20 |
| 1710322664 | Allyse Wharton | Physician Assistant | 350 30th St, Oakland, CA 94609-3424 | 2013-05-06 |
| 1578806329 | Aimee Keyashian | Internal Medicine | 350 30th St, #320, Oakland, CA 94609-3424 | 2013-03-30 |
| 1265774053 | Lynn Ellen Chiarello | Advanced Practice Midwife | 350 30th St, Suite 208, Oakland, CA 94609-3424 | 2013-03-20 |
| 1396001640 | Jennifer Brewster | Physician Assistant | 350 30th St, Suite 320, Oakland, CA 94609-3424 | 2012-04-11 |
| 1497012777 | Nicholas V Drbal | Podiatrist | 350 30th St, Suite 100, Oakland, CA 94609-3424 | 2012-04-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104457159 | Gerard John-charles Coughlin | Student in an Organized Health Care Education/Training Program | Samuel Merritt University, 3100 Telegraph Avenue, Oakland, CA 94609 | 2020-01-29 |
| 1417502022 | Michael Knittel | Registered Nurse | 370 Hawthorne Ave, Oakland, CA 94609 | 2019-08-09 |
| 1962057562 | Nicole Kjolby | Registered Nurse | Samuel Merritt College, 370 Hawthorne Ave, Oakland, CA 94609 | 2019-08-09 |
| 1396208286 | Graham Vallis | Student in an Organized Health Care Education/Training Program | Ucsf Benioff Children's Hospital Oakland, 747 52nd Street, Oakland, CA 94609 | 2019-04-09 |
| 1386129526 | Gary Mitchell Snider | Counselor | 390 40th Street, Oakland, CA 94609 | 2018-10-02 |
| 1720568389 | Lice Control Inc. | Technician | 6557 Shattuck Ave, Oakland, CA 94609 | 2018-08-14 |
| 1528559150 | Jenna Marie Kincaid | Behavior Technician | 400 29th St., 204, Oakland, CA 94609 | 2018-05-18 |
| 1336656669 | Nicholas Dicarlo | Social Worker | 465 34th St Ste 6, Oakland, CA 94609 | 2018-01-09 |
| 1174045744 | Theodora J Marzouk | Home Health Aide | 3317 Elm Street, Suite 202, Oakland, CA 94609 | 2017-07-14 |
| 1740728922 | Elena Gardella | Marriage & Family Therapist | 411 30th Street, Suite 412, Oakland, CA 94609 | 2017-02-07 |
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| Taxonomy Code | 207RG0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Gastroenterology |
| An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205161130 | Susie W Cohn | Internal Medicine | 300 Frank H Ogawa Plz Ste 450, Oakland, CA 94612-2047 | 2009-10-09 |
| 1851311104 | Ralph L Peterson | Internal Medicine | 10520 Macarthur Blvd, Oakland, CA 94605-5248 | 2006-07-20 |
| 1740232610 | Zealous D Wiley Jr. | Internal Medicine | 3300 Webster Street, Suite 312, Oakland, CA 94116 | 2006-05-17 |
| 1790743292 | Earl Michael Darby | Internal Medicine | 300 Frank H Ogawa Plz, Suite 450, Oakland, CA 94612-2037 | 2006-05-03 |
| 1225095763 | Neil H Stollman | Internal Medicine | 300 Frank Ogawa Plaza, Suite 450, Oakland, CA 94612 | 2006-04-27 |
| 1255305447 | Eddie C Cheung | Internal Medicine | 388 9th St Ste 218, Oakland, CA 94607-4293 | 2006-02-14 |
| 1942598396 | Ayesha Zahiruddin | Internal Medicine | 1411 E 31st St, Oakland, CA 94602-1092 | 2011-07-19 |
| 1376785048 | Hank S. Wang | Internal Medicine | 275 W Macarthur, Oakland, CA 94611-5641 | 2009-03-27 |
| 1306004106 | Eddie C Cheung Md | Internal Medicine | 3330 Telegraph Ave, Oakland, CA 94609-3025 | 2008-05-28 |
| 1417170937 | George Pavlou, Md, LLC | Internal Medicine | 19 Yawpo Ave., Oakland, NJ 07436 | 2007-04-11 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.