Provider Demographics
NPI:1902932734
Name:STEIN, MERVYN R (MD)
Entity Type:Individual
Prefix:
First Name:MERVYN
Middle Name:R
Last Name:STEIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:950 NORTHGATE DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3433
Mailing Address - Country:US
Mailing Address - Phone:415-479-2372
Mailing Address - Fax:415-472-6225
Practice Address - Street 1:950 NORTHGATE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3433
Practice Address - Country:US
Practice Address - Phone:415-479-2372
Practice Address - Fax:415-472-6225
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA00G164240207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G164240Medicaid
CA00G164240Medicare ID - Type Unspecified
CA00G164240Medicaid