Provider Demographics
NPI:1609857077
Name:AMSTERDAM, EZRA A (MD)
Entity type:Individual
Prefix:DR
First Name:EZRA
Middle Name:A
Last Name:AMSTERDAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:SUITE 2820
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-724-3764
Mailing Address - Fax:916-734-8394
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:SUITE 2820
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-724-3764
Practice Address - Fax:916-734-8394
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2011-08-12
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Provider Licenses
StateLicense IDTaxonomies
CAG018041207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G018041Medicare PIN
CAA40254Medicare UPIN