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Organization
WASHINGTON TOWNSHIP MEDICAL GROUP
Active
Organization
WASHINGTON TOWNSHIP MEDICAL GROUP
Active
Other names
Washington Township Medical Group, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALBERT L BROOKS MD (PRESIDENT)
(510) 248-1000
Entity
Organization
Contact information
Practice address
38690 STIVERS ST, SUITE A, FREMONT, CA 94536-5279
(510) 248-1040
(510) 797-7426
Mailing address
39141 CIVIC CENTER DR, SUITE 220, FREMONT, CA 94538-5818
(510) 248-1000
(510) 608-6055
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G36600
CA
207Y00000X
Otolaryngology Physician
G36600
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0104740
—
CA
01
—
ZZZ69533Z
BLUE SHIELD GRP PIN
CA
01
—
ZZZ69534Z
BLUE SHIELD 2ND LOCATION
CA
Enumeration date
01/17/2007
Last updated
06/17/2015
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