Provider Demographics
NPI:1215935630
Name:DORFMAN, JOAN SUSAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:SUSAN
Last Name:DORFMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1992
Mailing Address - Country:US
Mailing Address - Phone:510-527-4998
Mailing Address - Fax:
Practice Address - Street 1:575 MARKET ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-2854
Practice Address - Country:US
Practice Address - Phone:415-904-9676
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG021476208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics