Provider Demographics
NPI:1548353394
Name:NORMAN KEITH ASHBURN MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:NORMAN KEITH ASHBURN MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:N.
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:ASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-391-2400
Mailing Address - Street 1:2211 W. MAGNOLIA BLVD.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506
Mailing Address - Country:US
Mailing Address - Phone:818-391-2400
Mailing Address - Fax:818-391-2409
Practice Address - Street 1:2211 W. MAGNOLIA BLVD.
Practice Address - Street 2:SUITE 210
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506
Practice Address - Country:US
Practice Address - Phone:818-391-2400
Practice Address - Fax:818-391-2409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49733208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD388472Medicare UPIN
CAWA49733CMedicare ID - Type Unspecified