Provider Demographics
NPI:1487885075
Name:IRENE BEISSNER MD INC
Entity type:Organization
Organization Name:IRENE BEISSNER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEISSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-864-5556
Mailing Address - Street 1:1514 ROCKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1330
Mailing Address - Country:US
Mailing Address - Phone:707-864-5556
Mailing Address - Fax:707-745-1902
Practice Address - Street 1:1100 ROSE DR
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-3623
Practice Address - Country:US
Practice Address - Phone:707-745-1720
Practice Address - Fax:707-745-1902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42256207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23230OtherAMERICAN COLLEGE OF OB/GYN
CAA89129Medicare UPIN