Provider Demographics
NPI:1801161047
Name:ARA A. POLADIAN, M.D.,FACOG,PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ARA A. POLADIAN, M.D.,FACOG,PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:POLADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-763-2992
Mailing Address - Street 1:10876 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2236
Mailing Address - Country:US
Mailing Address - Phone:818-763-2992
Mailing Address - Fax:818-763-6054
Practice Address - Street 1:10876 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-2236
Practice Address - Country:US
Practice Address - Phone:818-763-2992
Practice Address - Fax:818-763-6054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40162305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85396Medicare UPIN