Provider Demographics
NPI:1497924864
Name:MORADIAN, MAXIM (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXIM
Middle Name:
Last Name:MORADIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MAX
Other - Middle Name:
Other - Last Name:MORADIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2627 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1412
Mailing Address - Country:US
Mailing Address - Phone:626-797-2002
Mailing Address - Fax:626-798-0567
Practice Address - Street 1:800 S CENTRAL AVE STE 301
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4388
Practice Address - Country:US
Practice Address - Phone:818-338-6860
Practice Address - Fax:888-425-9079
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442485208100000X
LAMD202793208100000X
CAA118692208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1006289Medicaid