Provider Demographics
NPI:1639128556
Name:TANIOS, MAGED A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAGED
Middle Name:A
Last Name:TANIOS
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:PO BOX 32025
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90832-2025
Mailing Address - Country:US
Mailing Address - Phone:562-424-8000
Mailing Address - Fax:562-424-8006
Practice Address - Street 1:3605 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4026
Practice Address - Country:US
Practice Address - Phone:562-424-8000
Practice Address - Fax:562-424-8006
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74946174400000X, 207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A749460Medicaid
CA00A749460Medicaid
CAG54320Medicare UPIN
CAW18255Medicare ID - Type UnspecifiedMEDICARE NUMBER