Provider Demographics
NPI:1285915082
Name:SIDNEY M MARCHASIN MD INC
Entity type:Organization
Organization Name:SIDNEY M MARCHASIN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARCHASIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-363-8352
Mailing Address - Street 1:39 BIRCH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062
Mailing Address - Country:US
Mailing Address - Phone:650-363-8352
Mailing Address - Fax:650-363-8438
Practice Address - Street 1:39 BIRCH ST
Practice Address - Street 2:SUITE C
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-1482
Practice Address - Country:US
Practice Address - Phone:650-363-8352
Practice Address - Fax:650-363-8438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA19161305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization