Provider Demographics
NPI:1437463957
Name:MARCOS B FLEIDERMAN M D MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MARCOS B FLEIDERMAN M D MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:B
Authorized Official - Last Name:FLEIDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-881-8610
Mailing Address - Street 1:18372 CLARK ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3508
Mailing Address - Country:US
Mailing Address - Phone:818-881-8610
Mailing Address - Fax:818-881-4260
Practice Address - Street 1:18372 CLARK ST
Practice Address - Street 2:SUITE 212
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3508
Practice Address - Country:US
Practice Address - Phone:818-881-8610
Practice Address - Fax:818-881-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA82436Medicare UPIN