Provider Demographics
NPI:1144336355
Name:LANDMAN, PETRA FROEHLICH (MD)
Entity type:Individual
Prefix:
First Name:PETRA
Middle Name:FROEHLICH
Last Name:LANDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PETRA
Other - Middle Name:N
Other - Last Name:FROEHLICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:510-204-5600
Mailing Address - Fax:510-204-5462
Practice Address - Street 1:2500 MILVIA ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2636
Practice Address - Country:US
Practice Address - Phone:510-204-5600
Practice Address - Fax:510-204-5462
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60639208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G606390Medicaid
CAG60639OtherSTATE MEDICAL LICENSE
CAG60639OtherSTATE MEDICAL LICENSE