EAST BAY NEPHROLOGY MEDICAL GROUP, INC. (NPI# 1871699074) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871699074 |
| Entity Type | Organization |
| Organization Name | EAST BAY NEPHROLOGY MEDICAL GROUP, INC. |
| Practice Address |
2905 Telegraph Ave Berkeley CA 94705-2063 |
| Practice Telephone | 5108414525 |
| Practice Fax Number | 5108489970 |
| Mailing Telephone | (510) 841-4525 |
| Mailing Fax Number | 5108489970 |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2017-09-05 |
| Authorized Official Name | THOMAS A TURNER (CHIEF OPERATING OFFICER) |
| Authorized Official Telephone | 5108410411 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | RAILROAD MEDICARE GROUP # | CR0683 | 01 |
| CA | GR0049640 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275628992 | East Bay Nephrology Medical Group, Inc. | Internal Medicine | 14020 San Pablo Ave, Ste A, San Pablo, CA 94806-3604 | 2006-10-04 |
| 1184719809 | East Bay Nephrology Medical Group, Inc. | Internal Medicine | 125 Hospital Dr, Vallejo, CA 94589-2562 | 2006-10-04 |
| Street Address |
2905 TELEGRAPH AVE |
| City | BERKELEY |
| State | CA |
| Zip Code | 94705-2063 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306314828 | Suzanne D Lee | Dietitian, Registered | 2905 Telegraph Ave, Berkeley, CA 94705-2017 | 2018-11-02 |
| 1538635966 | Helen Kalasa Mwanza | Nurse Practitioner | 2905 Telegraph Ave, Berkeley, CA 94705-2017 | 2018-10-24 |
| 1568991701 | Rahitha Maria Thomas | Registered Nurse | 2905 Telegraph Ave, Berkeley, CA 94705-2017 | 2017-06-10 |
| 1952776791 | Chhaya B Patel | Dietitian, Registered | 2905 Telegraph Ave, Berkeley, CA 94705-2017 | 2015-12-04 |
| 1336534585 | Warda Zaman | Internal Medicine | 2905 Telegraph Ave, Berkeley, CA 94705-2017 | 2015-04-04 |
| 1922425057 | Michael James Ajuria | Internal Medicine | 2905 Telegraph Ave, Berkeley, CA 94705-2017 | 2014-03-26 |
| 1861834996 | Manasi Bapat | Internal Medicine | 2905 Telegraph Ave, Berkeley, CA 94705 | 2013-07-17 |
| 1699094292 | Vikram Suri | Internal Medicine | 2905 Telegraph Ave, Berkeley, CA 94705-2017 | 2010-05-21 |
| 1306072640 | Golaun Odabaei | Internal Medicine | 2905 Telegraph Ave, Berkeley, CA 94705-2017 | 2009-06-01 |
| 1164667549 | Alexis R Chettiar | Nurse Practitioner | 2905 Telegraph Ave, Berkeley, CA 94705-2017 | 2008-12-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447882956 | Diane Lomas Wyatt | Marriage & Family Therapist | 2340 Ward St. Ste 104, Berkeley, CA 94705 | 2020-02-12 |
| 1700371275 | Icecreamwala Dermatology Inc | Dermatology | 2435 Webster St Ste 101, Berkeley, CA 94705 | 2018-06-27 |
| 1396253803 | David R Shaddock | Marriage & Family Therapist | 3030 Ashby Avenue, # 105, Berkeley, CA 94705 | 2018-01-18 |
| 1821504432 | Allegra Tringali | Physical Therapist | 2450 Ashby Ave Fl 6, Berkeley, CA 94705 | 2017-12-19 |
| 1659898740 | Hunter Brown | Student in an Organized Health Care Education/Training Program | Wright Institute Clinical Services 1918 University Ave, Suite 2b, Berkeley, CA 94705 | 2017-08-29 |
| 1588014534 | Heather Valdez | Social Worker | 2185 Ashby Ave, Berkeley, CA 94705 | 2016-06-20 |
| 1215350145 | S.e.e.d.s. (social and Emotional Education Development and Support) | Community/Behavioral Health | 3120 Telegraph Avenue Ste 9, Berkeley, CA 94705 | 2014-01-29 |
| 1144580960 | Benjamin Tucker | Counselor | 2625 Alcatraz Ave Ste 609, Berkeley, CA 94705 | 2012-05-26 |
| 1881966141 | Jennifer Cowherd | Behavioral Analyst | 2201 Woolsey St, Berkeley, CA 94705 | 2012-02-02 |
| 1518255892 | Erika D Huguenard | Counselor | 2811a College Avenue, Berkeley, CA 94705 | 2011-07-20 |
| Find all providers in zip 94705 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336534585 | Warda Zaman | Internal Medicine | 2905 Telegraph Ave, Berkeley, CA 94705-2017 | 2015-04-04 |
| 1922425057 | Michael James Ajuria | Internal Medicine | 2905 Telegraph Ave, Berkeley, CA 94705-2017 | 2014-03-26 |
| 1861834996 | Manasi Bapat | Internal Medicine | 2905 Telegraph Ave, Berkeley, CA 94705 | 2013-07-17 |
| 1255599270 | Veena Manjunath | Internal Medicine | 2905 Telegraph Ave, Berkeley, CA 94705-2017 | 2008-05-27 |
| 1235212044 | Katherine Rausa | Internal Medicine | 2905 Telegraph Ave, Montefiore Medical Center, Berkeley, CA 94705-2017 | 2006-10-23 |
| 1972600229 | Terry M Maher | Internal Medicine | 2905 Telegraph Ave, Berkeley, CA 94705-2063 | 2006-09-20 |
| 1407953755 | Bryan M Wong | Internal Medicine | 2905 Telegraph Ave, Berkeley, CA 94705-2063 | 2006-09-20 |
| 1902903578 | Monte M Wu | Internal Medicine | 2905 Telegraph Ave, Berkeley, CA 94705 | 2006-09-17 |
| 1548367113 | Claudia I Iota-herbei | Internal Medicine | 2905 Telegraph Ave, Berkeley, CA 94705-2063 | 2006-09-17 |
| 1184721821 | Robert B Doud | Internal Medicine | 2905 Telegraph Ave, Berkeley, CA 94705-2063 | 2006-09-17 |
| Find all providers in BERKELEY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.