Provider Demographics
NPI:1861569279
Name:DENIS W DREW M.D. INC AND STEPHEN RASKIN MD INC A PARTNERSHIP
Entity type:Organization
Organization Name:DENIS W DREW M.D. INC AND STEPHEN RASKIN MD INC A PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-522-6323
Mailing Address - Street 1:2070 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4399
Mailing Address - Country:US
Mailing Address - Phone:510-522-6323
Mailing Address - Fax:510-522-5078
Practice Address - Street 1:2070 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4399
Practice Address - Country:US
Practice Address - Phone:510-522-6323
Practice Address - Fax:510-522-5078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY49276YMedicaid
CAYYY49276YMedicaid