NPIMap

Individual provider Active NPI

Maryna Vazmitsel, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Berkeley, CA
National Provider Identifier
1245767029
Registry record updated Feb 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
A170398 Issued in CA
Practice address
2510 Webster St
Berkeley, CA 94705-2557
Phone
(510) 548-6555
NPI assigned
May 11, 2017
Last updated
Feb 10, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X A170398 CA Primary

Addresses

Primary practice location

2510 Webster St
Berkeley, CA 94705-2557

Mailing address

2510 Webster St
Berkeley, CA 94705-2557
Phone (510) 548-6555

Other practice location 1

350 Hawthorne Ave
Oakland, CA 94609-3108
Phone (510) 869-6567

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220610002075 CA Practitioner - Pathology 6406234913 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bass Medical GroupGroup PAC ID 9032111281, 292 clinicians
Alta East Bay Pathology, Inc.Group PAC ID 8224024013, 6 clinicians

Practice addresses (Care Compare)

1505 Saint Alphonsus Way
Alamo, CA 94507-1570
Phone (925) 932-6330

20103 Lake Chabot Rd
Castro Valley, CA 94546-5305
Phone (510) 727-3036

2450 Ashby Ave
Berkeley, CA 94705-2067
Phone (510) 204-1642

350 Hawthorne Ave
Oakland, CA 94609-3108
Phone (510) 869-6567

365 Lennon LN
Walnut Creek, CA 94598-5915

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A170398CAMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alta East Bay Pathology, Inc. Anatomic Pathology & Clinical Pathology CurrentSince May 1, 2022 Accepting new patients
Bass Medical Group Current Accepting new patients
Alta East Bay Pathology, Inc. Current Accepting new patients
Bass Medical Group CurrentSince Jul 1, 2022 Accepting new patients
Bass Medical Group CurrentSince Jul 1, 2022 Accepting new patients
Bass Medical Group Past Accepting new patients
Sutter Bay Hospitals Past Accepting new patients

Locations

1505 Saint Alphonsus Way
Alamo, CA 94507
Phone (925) 837-4225

2450 Ashby Ave
Berkeley, CA 94705
Phone (510) 204-1566

2510 Webster St
Berkeley, CA 94705
Phone (510) 548-6555

20103 Lake Chabot Rd
Hayward, CA 94546
Phone (510) 537-1234

350 Hawthorne Ave
Oakland, CA 94609
Phone (510) 655-4000

365 Lennon Ln
Ste 250
Walnut Creek, CA 94598
Phone (925) 627-3424

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1494460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739145600000",
    "number": "1245767029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 WEBSTER ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052557",
            "telephone_number": "510-548-6555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 WEBSTER ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947052557",
            "telephone_number": "510-548-6555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 Hawthorne Ave",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946093108",
            "country_code": "US",
            "telephone_number": "510-869-6567",
            "fax_number": "510-869-6707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAZMITSEL",
        "first_name": "MARYNA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-11",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "A170398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berkeley, CA

Sources for this page

Verify at the official NPI Registry.