MARIN MEDICAL LABORATORIES (NPI# 1962504977) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962504977 |
| Entity Type | Organization |
| Organization Name | MARIN MEDICAL LABORATORIES |
| Other Organization Name | MARIN MEDICAL LABS NUCLEAR MEDICAL GROUP |
| Practice Address |
1300 South Eliseo Drive Suite 102 Greenbrae CA 94904 |
| Mailing Address |
1615 Hill Road Suite B Novato CA 94947 |
| Practice Telephone | 4159256967 |
| Practice Fax Number | 4154614913 |
| Mailing Telephone | 4158987649 |
| Mailing Fax Number | 4158980870 |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2007-10-23 |
| Authorized Official Name | DR. PAUL WILLIAM WASSERSTEIN (MANAGING PARTNER) |
| Authorized Official Telephone | 4159257174 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085B0100X |
Radiology Specialization: Body Imaging |
CLIA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | LAB00787F | 05 |
| Other Name | Type Code |
|---|---|
| Marin Medical Labs Nuclear Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144326471 | Marin Medical Laboratories | Pathology | 1615 Hill Road, Suite B, Novato, CA 94947 | 2006-09-15 |
| 1326444647 | Marin Medical Laboratories | Pathology | 1165 Montgomery Dr, Santa Rosa, CA 95405-4801 | 2014-11-13 |
| 1346532314 | Marin Medical Laboratories | Pathology | 347 Andrieux St, Sonoma, CA 95476-6811 | 2011-05-10 |
| 1720393838 | Marin Medical Laboratories | Pathology | 3325 Chanate Rd, Santa Rosa, CA 95404-1707 | 2010-08-12 |
| 1447356811 | Marin Medical Laboratories | Pathology | 250 Bon Air Road, Greenbrae, CA 94904 | 2006-09-15 |
| 1336245653 | Marin Medical Laboratories | Nuclear Medicine | 180 Rowland Way, Novato, CA 94947 | 2006-09-15 |
| 1053417386 | Marin Medical Laboratories | Pathology | 250 Bon Air Road, Greenbrae, CA 94904 | 2006-09-15 |
| 1013025634 | Marin Medical Laboratories | Nuclear Medicine | 250 Bon Air Road, Greenbrae, CA 94904 | 2006-08-25 |
| Street Address |
1300 SOUTH ELISEO DRIVE SUITE 102 |
| City | GREENBRAE |
| State | CA |
| Zip Code | 94904 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295382372 | Stacey Nicole Drew | Occupational Therapist | 4 Ash Ave, Unit 10, Kentfield, CA 94904 | 2019-08-22 |
| 1154781631 | Harvey Sparks | Specialist/Technologist, Other | 350 Bon Air, Ste 100, Greenbrae, CA 94904 | 2016-02-26 |
| 1396120481 | Tamena Potts | Counselor | 1109 Sir Francis Drake, Kentfield, CA 94904 | 2015-07-30 |
| 1598014763 | Rupali Ray Chaudhuri | Nurse Practitioner | 1341 S. Eliseo Dr, Suite 200, Greenbrae, CA 94904 | 2012-09-04 |
| 1326304809 | Lucy Yingxin Zhang | Ophthalmology | 900 S Eliseo Dr Ste 102, Greenbrae, CA 94904 | 2012-04-09 |
| 1396073185 | Bonnie Louise Hoag | Marriage & Family Therapist | 905 Sir Francis Drake Blvd., Ste. F., Kentfield, CA 94904 | 2009-12-07 |
| 1801043880 | Alexander Vogel Uihlein | Internal Medicine | 900 S Eliseo Dr Ste 201, Greenbrae, CA 94904 | 2008-08-21 |
| 1649426115 | Marilyn Thatcher | Psychologist | 1010 Sir Francis Drake Blve, Ste. 103, Kentfield, CA 94904 | 2008-08-14 |
| 1205007598 | Sir Francis Drake Dental | Dentist | 919 Sir Francis Drake Blvd, Kentfield, CA 94904 | 2008-03-14 |
| 1841401734 | Rishi K Wadhwa | Neurological Surgery | 1100 S Eliseo Dr Ste 1, Greenbrae, CA 94904 | 2007-05-24 |
| Find all providers in zip 94904 | ||||
| Taxonomy Code | 2085B0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Body Imaging |
| A Radiology doctor of Osteopathy that specializes in Body Imaging. |
| Notes: Source: National Uniform Claim Committee, 2008 [7/1/2008: definiton added, source added] Additional Resources: The American Osteopathic Board of Radiology no longer offers a certificate in this specialty. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730795881 | Valerie Rondone | Radiology | 2574 Raleigh Way, El Dorado Hills, CA 95762-6973 | 2020-09-23 |
| 1558997387 | Hope & Trust Trading LLC | Radiology | 318 W Colorado St #2, Glendale, CA 91204 | 2020-03-12 |
| 1417416124 | Adventist Health Physicians Network | Radiology | 155 Solano St Ste 101, Corning, CA 96021-3511 | 2019-03-13 |
| 1770068991 | Reham Aboughali | Radiology | 20349 Anza Ave Apt 27, Torrance, CA 90503-7410 | 2018-10-03 |
| 1962910513 | Excel Imaging Center Inc | Radiology | 13071 Brookhurst St Ste 100, Garden Grove, CA 92843-5514 | 2018-01-17 |
| 1467972315 | Radtech Services Inc | Radiology | 2826 Racine St, Simi Valley, CA 93065-2730 | 2017-06-22 |
| 1619363496 | Nathan Ashley | Radiology | 620 N Bonhill Rd, Los Angeles, CA 90049-2302 | 2015-04-08 |
| 1851709984 | Reveal Diagnostics, LLC | Radiology | 6080 Hellyer Ave, Suite 175, San Jose, CA 95138-1052 | 2014-08-01 |
| 1770912784 | William George Hayden | Radiology | 20 Ciervos Rd, Portola Valley, CA 94028-8107 | 2013-11-11 |
| 1215362942 | Reveal Diagnostics LLC | Radiology | 4217 Piedmont Avenue, Suite B, Oakland, CA 94611 | 2013-09-12 |
| Find all providers with the same taxonomy | ||||
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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.