Provider Demographics
NPI:1093878134
Name:TRADER, DAVID W (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:TRADER
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 1:9911 W PICO BLVD
Mailing Address - Street 2:SUITE 1460
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2703
Mailing Address - Country:US
Mailing Address - Phone:310-277-3883
Mailing Address - Fax:310-277-2644
Practice Address - Street 1:9911 W PICO BLVD
Practice Address - Street 2:SUITE 1460
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2703
Practice Address - Country:US
Practice Address - Phone:310-277-3883
Practice Address - Fax:310-277-2644
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG485282084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG048528Medicaid
CAG048528Medicaid
CAA92827Medicare UPIN