Provider Demographics
NPI:1609058544
Name:ROBERT B GHATAN M D INC
Entity Type:Organization
Organization Name:ROBERT B GHATAN M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GHATAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-289-7127
Mailing Address - Street 1:207 S SANTA ANITA STREET
Mailing Address - Street 2:SUITE 336
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1146
Mailing Address - Country:US
Mailing Address - Phone:626-289-7127
Mailing Address - Fax:626-289-8233
Practice Address - Street 1:207 S SANTA ANITA STREET
Practice Address - Street 2:SUITE 336
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1146
Practice Address - Country:US
Practice Address - Phone:626-289-7127
Practice Address - Fax:626-289-8233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30201207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADG9756OtherRAILROAD MEDICARE
CAW21625Medicare PIN