Advanced Medical and Surgical Dermatology Corporation

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

A65185 Issued in CA

Legal business name

ADVANCED MEDICAL AND SURGICAL DERMATOLOGY CORPORATION

Practice address

1099 D St Ste 204
San Rafael, CA 94901-2893

Phone

(415) 259-0131

Fax

(415) 259-0133

NPI assigned

May 4, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Anya Bandt, M.D.

Title

President

Phone

(415) 259-0131

Specialties & licenses 5

Addresses

Locations

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

{
    "created_epoch": "1304467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304467200000",
    "number": "1720370166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1099 D ST STE 204",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012893",
            "telephone_number": "415-259-0131",
            "fax_number": "415-259-0133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1099 D ST STE 204",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012893",
            "telephone_number": "415-259-0131",
            "fax_number": "415-259-0133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED MEDICAL AND SURGICAL DERMATOLOGY CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-04",
        "last_updated": "2011-05-04",
        "status": "A",
        "authorized_official_last_name": "BANDT",
        "authorized_official_first_name": "ANYA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "415-259-0131",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A65185",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "A65186",
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "CA",
            "license": "A65186",
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "CA",
            "license": "A65186",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "A65186",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.