Provider Demographics
NPI:1235103813
Name:PADULA, ANTHONY S (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:S
Last Name:PADULA
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 1:120 LA CASA VIA
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3067
Mailing Address - Country:US
Mailing Address - Phone:925-210-1050
Mailing Address - Fax:925-210-1082
Practice Address - Street 1:120 LA CASA VIA
Practice Address - Street 2:SUITE 204
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3067
Practice Address - Country:US
Practice Address - Phone:925-210-1050
Practice Address - Fax:925-210-1082
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83508207R00000X, 207RR0500X, 2080P0216X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI34648Medicare UPIN
CA00A835080Medicare ID - Type Unspecified