Organization
HEADQUARTERS MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUCAS JOHNSTON (OPERATIONS ADMINISTRATOR)
(973) 270-3396
Entity
Organization
Contact information
Practice address
2340 VAN NESS AVE APT 5, SAN FRANCISCO, CA 94109-1848
(415) 763-5790
Mailing address
2340 VAN NESS AVE APT 5, SAN FRANCISCO, CA 94109-1848
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
2080S0010X
Pediatric Sports Medicine Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081P0301X
Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician
—
—
2084N0400X
Neurology Physician
—
—
2084P0301X
Brain Injury Medicine (Psychiatry & Neurology) Physician
—
—
225100000X
Physical Therapist
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/17/2025
Last updated
09/17/2025
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