Provider Demographics
NPI:1063504249
Name:RAD, BEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:
Last Name:RAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBEN
Other - Middle Name:
Other - Last Name:MORADZADEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4590 E CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-2659
Mailing Address - Country:US
Mailing Address - Phone:559-252-0500
Mailing Address - Fax:559-252-2804
Practice Address - Street 1:4590 E CLINTON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-2659
Practice Address - Country:US
Practice Address - Phone:559-252-0500
Practice Address - Fax:559-252-2804
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40892207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29234Medicare UPIN