Provider Demographics
NPI:1932256294
Name:MARINER MEDICAL CENTER
Entity type:Organization
Organization Name:MARINER MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-570-2299
Mailing Address - Street 1:1241 E HILLSDALE BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1241
Mailing Address - Country:US
Mailing Address - Phone:650-570-2299
Mailing Address - Fax:650-570-5949
Practice Address - Street 1:1261 E HILLSDALE BLVD
Practice Address - Street 2:STE 1
Practice Address - City:FOSTER CITY
Practice Address - State:CA
Practice Address - Zip Code:94404-1236
Practice Address - Country:US
Practice Address - Phone:650-570-2299
Practice Address - Fax:650-570-5949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83248207N00000X
CAA80784207Q00000X
CAG79688207R00000X
CAG48428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty