Provider Demographics
NPI:1508884438
Name:MADANAT, NABEEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:NABEEL
Middle Name:J
Last Name:MADANAT
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 1:1828 EL CAMINO REAL
Mailing Address - Street 2:SUITE 701
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3103
Mailing Address - Country:US
Mailing Address - Phone:650-652-9022
Mailing Address - Fax:650-652-9029
Practice Address - Street 1:1828 EL CAMINO REAL
Practice Address - Street 2:SUITE 701
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3103
Practice Address - Country:US
Practice Address - Phone:650-652-9022
Practice Address - Fax:650-652-9029
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50176174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A501760Medicaid
CAA18428Medicare UPIN