Pederson, Mark Newman

Pederson, Mark Newman is an individual health care provider with primary practice located at 1783 El Camino Real , Burlingame CA 94010-3205. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Pederson, Mark Newman can be contacted via phone (650) 696-5515.

Contact Information

Primary practice address
1783 El Camino Real Burlingame CA 94010-3205
Phone: (650) 696-5515
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X G33814 California

Profile Details

NPI number 1063457034
LBN Legal business name Pederson, Mark Newman
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2006
Last updated Feb 6th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063457034 NPPES
California MEDICAID 00G338140
California Other 300121863

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