Provider Demographics
NPI:1164476347
Name:ESKAROUS, NADY I (MD)
Entity Type:Individual
Prefix:
First Name:NADY
Middle Name:I
Last Name:ESKAROUS
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 1:416 E BROADWAY UNIT 311
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1086
Mailing Address - Country:US
Mailing Address - Phone:818-265-2200
Mailing Address - Fax:818-265-2201
Practice Address - Street 1:801 S CHEVY CHASE DR STE 105
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4432
Practice Address - Country:US
Practice Address - Phone:818-265-2200
Practice Address - Fax:818-265-2201
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55850207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIF48605Medicare UPIN
WI019940674Medicare PIN
WI462364895Medicare PIN
WI0241Medicare PIN
WIP01024054OtherRR MEDICARE
WI31900900Medicaid