Provider Demographics
NPI:1215083035
Name:RICHARD R. TAVERNETTI, M.D., INC
Entity type:Organization
Organization Name:RICHARD R. TAVERNETTI, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ROLAND
Authorized Official - Last Name:TAVERNETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-923-3033
Mailing Address - Street 1:2100 WEBSTER ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2373
Mailing Address - Country:US
Mailing Address - Phone:415-923-3033
Mailing Address - Fax:415-923-3083
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:SUITE 115
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:415-923-3033
Practice Address - Fax:415-923-3083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23135207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1558452151OtherNPI FOR INDIVIDUAL
CA00A231350OtherPRIVATE HEALTH INS CARRIE
CA00A231350Medicaid
CAP00064486Medicare PIN
CA00A231350Medicaid
CA1558452151OtherNPI FOR INDIVIDUAL