Provider Demographics
NPI:1235550351
Name:ATTILA MADY
Entity Type:Organization
Organization Name:ATTILA MADY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ATTILA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-248-2515
Mailing Address - Street 1:PO BOX 4483
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95402-4483
Mailing Address - Country:US
Mailing Address - Phone:213-248-2515
Mailing Address - Fax:702-453-5741
Practice Address - Street 1:1375 UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3382
Practice Address - Country:US
Practice Address - Phone:707-431-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty