Provider Demographics
NPI:1174636039
Name:TROY, ANN (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:TROY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 NORTHGATE DR
Mailing Address - Street 2:SUITE #9
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3429
Mailing Address - Country:US
Mailing Address - Phone:415-479-9797
Mailing Address - Fax:415-479-9712
Practice Address - Street 1:920 NORTHGATE DR
Practice Address - Street 2:SUITE #9
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3429
Practice Address - Country:US
Practice Address - Phone:415-479-9797
Practice Address - Fax:415-479-9712
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA41505208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE96797Medicare UPIN