Provider Demographics
NPI:1447218045
Name:TANENBAUM, BARTON (MD)
Entity Type:Individual
Prefix:
First Name:BARTON
Middle Name:
Last Name:TANENBAUM
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 1:1127 WILSHIRE BLVD STE 805
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3909
Mailing Address - Country:US
Mailing Address - Phone:213-484-9900
Mailing Address - Fax:213-484-0158
Practice Address - Street 1:201 S ALVARADO ST
Practice Address - Street 2:SUITE 215
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2320
Practice Address - Country:US
Practice Address - Phone:213-484-9900
Practice Address - Fax:213-484-0158
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19250208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0385570001OtherMEDICARE DME
CA0385570002OtherMEDICARE DME
CA340018176OtherRR MEDICARE
CA341916018OtherRR MEDICARE
CA00G129500Medicaid
CALAB94467FMedicaid
CA00G192501Medicaid
CAG19250BMedicare PIN
CA341916018OtherRR MEDICARE
CA340018176OtherRR MEDICARE
CA0385570001OtherMEDICARE DME