1356451488 NPI number — STEPHEN J CARNEY M.D.

Table of content: STEPHEN J CARNEY M.D. (NPI 1356451488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356451488 NPI number — STEPHEN J CARNEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARNEY
Provider First Name:
STEPHEN
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356451488
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 EL CAMINO REAL
Provider Second Line Business Mailing Address:
STE 236
Provider Business Mailing Address City Name:
BURLINGAME
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94010-3111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-651-7112
Provider Business Mailing Address Fax Number:
650-689-5271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1860 EL CAMINO REAL
Provider Second Line Business Practice Location Address:
STE 236
Provider Business Practice Location Address City Name:
BURLINGAME
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94010-3111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-651-7112
Provider Business Practice Location Address Fax Number:
650-689-5271
Provider Enumeration Date:
08/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  G61092 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)