Provider Demographics
NPI:1508971284
Name:MICHAEL S REARDON,MD.INC.
Entity Type:Organization
Organization Name:MICHAEL S REARDON,MD.INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:REARDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-617-8655
Mailing Address - Street 1:900 WELCH RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1805
Mailing Address - Country:US
Mailing Address - Phone:650-617-8655
Mailing Address - Fax:650-322-3416
Practice Address - Street 1:900 WELCH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1805
Practice Address - Country:US
Practice Address - Phone:650-617-8655
Practice Address - Fax:650-322-3416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA305752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02555ZMedicare PIN
CAA26153Medicare UPIN