Provider Demographics
NPI:1083715908
Name:LONDON, STUART S (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:S
Last Name:LONDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 TELEGRAPH AVE.
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3028
Mailing Address - Country:US
Mailing Address - Phone:510-420-8800
Mailing Address - Fax:510-420-8069
Practice Address - Street 1:3330 TELEGRAPH AVE.
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3028
Practice Address - Country:US
Practice Address - Phone:510-420-8800
Practice Address - Fax:510-420-8069
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG270022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G270020Medicaid
CA00G270020Medicaid
CAA43174Medicare UPIN