Provider Demographics
NPI:1316982879
Name:GENERAL VASCULAR SURGERY MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:GENERAL VASCULAR SURGERY MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:O
Authorized Official - Last Name:GINGERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-347-4700
Mailing Address - Street 1:13851 E 14TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2631
Mailing Address - Country:US
Mailing Address - Phone:510-347-4700
Mailing Address - Fax:510-347-4712
Practice Address - Street 1:13851 E 14TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2631
Practice Address - Country:US
Practice Address - Phone:510-347-4700
Practice Address - Fax:510-347-4712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29924ZMedicare PIN
CACR0889Medicare PIN
CAZZZ94434ZMedicare PIN
CAZZZ15705ZMedicare PIN
CAZZZ99495ZMedicare PIN
CAZZZ99493ZMedicare PIN