| Washington Township Medical Group, Inc | |
|
38690 Stivers St Suite A Fremont CA 94536-5279 | |
| (510) 248-1040 | |
| (510) 797-7426 |
| Full Name | Washington Township Medical Group, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 38690 Stivers St, Fremont, California |
| Authorized Official Name and Position | Albert L Brooks (PRESIDENT) |
| Authorized Official Contact | 5102481000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Washington Township Medical Group, Inc 39141 Civic Center Dr Suite 220 Fremont CA 94538-5818 Ph: (510) 248-1000 | Washington Township Medical Group, Inc 38690 Stivers St Suite A Fremont CA 94536-5279 Ph: (510) 248-1040 |
| NPI Number | 1174675417 |
|---|---|
| Provider Enumeration Date | 01/17/2007 |
| Last Update Date | 06/17/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174675417 | NPI | - | NPPES |
| GR0104740 | Medicaid | CA | |
| ZZZ69534Z | Other | CA | BLUE SHIELD 2ND LOCATION |
| ZZZ69533Z | Other | CA | BLUE SHIELD GRP PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G36600 (California) | Primary |
| 207Y00000X | Otolaryngology | G36600 (California) | Secondary |
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