Provider Demographics
NPI:1427091016
Name:DEMARTINI, WILLIAM JAMES (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:DEMARTINI
Suffix:
Gender:M
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:PO BOX 6102
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-6102
Mailing Address - Country:US
Mailing Address - Phone:415-884-3418
Mailing Address - Fax:415-883-8082
Practice Address - Street 1:250 BON AIR RD
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:415-925-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG279052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G279050Medicaid
CA300121750OtherRAILROAD MEDICARE
CA00G279059Medicare PIN
CABY132YMedicare PIN
CA00G279050Medicare PIN
CABY132WMedicare PIN
CA00G279055Medicare PIN
CABY132XMedicare PIN
CA00G279054Medicare PIN
CA00G279057Medicare PIN
CA300121750OtherRAILROAD MEDICARE
CAA43540Medicare UPIN
CA00G279058Medicare PIN
CA00G279052Medicare PIN