Provider Demographics
NPI:1487784286
Name:THOMAS O. STODGEL, MD
Entity type:Organization
Organization Name:THOMAS O. STODGEL, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:STODGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-344-7799
Mailing Address - Street 1:101 S SAN MATEO DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3819
Mailing Address - Country:US
Mailing Address - Phone:650-344-7799
Mailing Address - Fax:650-344-7802
Practice Address - Street 1:101 S SAN MATEO DR
Practice Address - Street 2:SUITE 112
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3819
Practice Address - Country:US
Practice Address - Phone:650-344-7799
Practice Address - Fax:650-344-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA049612207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A049612Medicaid
CA00C503460Medicaid
CA00A049612Medicaid
CA00C503460Medicaid