Provider Demographics
NPI:1063559698
Name:HILLTOP PEDIATRICS MEDICAL GROUP
Entity type:Organization
Organization Name:HILLTOP PEDIATRICS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGERY
Authorized Official - Middle Name:
Authorized Official - Last Name:LACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-222-5437
Mailing Address - Street 1:2970 HILLTOP MALL RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1947
Mailing Address - Country:US
Mailing Address - Phone:510-222-5437
Mailing Address - Fax:510-222-5487
Practice Address - Street 1:2970 HILLTOP MALL RD
Practice Address - Street 2:SUITE 305
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-1947
Practice Address - Country:US
Practice Address - Phone:510-222-5437
Practice Address - Fax:510-222-5487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP 14657208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty