Provider Demographics
NPI:1700883733
Name:MD MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:MD MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-243-1232
Mailing Address - Street 1:7585 N CEDAR AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2604
Mailing Address - Country:US
Mailing Address - Phone:559-243-1232
Mailing Address - Fax:559-243-9954
Practice Address - Street 1:7585 N CEDAR AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2604
Practice Address - Country:US
Practice Address - Phone:559-243-1232
Practice Address - Fax:559-243-9954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA667692084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0100150Medicaid
CAZZZ25147ZMedicare ID - Type Unspecified
CAZZZ25148ZMedicare ID - Type Unspecified