NPIMap

Organization Active NPI

Fremont Dermatology Medical Office

  • Specialist
  • Fremont, CA
National Provider Identifier
1841487337
Registry record updated Sep 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
C042190 Issued in CA
Legal business name
FREMONT DERMATOLOGY MEDICAL OFFICE
Practice address
39210 State St Ste 218
Fremont, CA 94538-1456
Phone
(510) 790-0477
NPI assigned
Sep 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2008

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

Authorized official

Name
Dr. David C Gorsulowsky, M.D.NPI 1649272832
Title
Physician
Phone
(510) 790-0477

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X C042190 CA Primary

Addresses

Primary practice location

39210 State St Ste 218
Fremont, CA 94538-1456

Mailing address

39210 State St Ste 218
Fremont, CA 94538-1456
Phone (510) 790-0477

Other identifiers 2

IdentifierTypeStateIssuer
A37754OtherCAUPIN
070008967OtherCARAILROAD MEDICARE ID

National Provider Directory

National Provider Directory

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1190851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222387200000",
    "number": "1841487337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39210 STATE ST STE 218",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381456",
            "telephone_number": "510-790-0477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39210 STATE ST STE 218",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381456",
            "telephone_number": "510-790-0477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREMONT DERMATOLOGY MEDICAL OFFICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-27",
        "last_updated": "2008-09-26",
        "status": "A",
        "authorized_official_last_name": "GORSULOWSKY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "510-790-0477",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "C042190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "A37754",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE ID",
            "identifier": "070008967",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2008; 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.