Provider Demographics
NPI:1316145469
Name:FIRST MED MARIN MEDICAL CLINIC
Entity type:Organization
Organization Name:FIRST MED MARIN MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:SANDFORD
Authorized Official - Last Name:LANDFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-461-3500
Mailing Address - Street 1:900 S ELISEO DR STE 202
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2153
Mailing Address - Country:US
Mailing Address - Phone:415-461-3500
Mailing Address - Fax:415-461-3891
Practice Address - Street 1:900 S ELISEO DR STE 202
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2153
Practice Address - Country:US
Practice Address - Phone:415-461-3500
Practice Address - Fax:415-461-3891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19884207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40779Medicare UPIN
CAZZZ11297ZMedicare PIN