Provider Demographics
NPI: | 1639275670 |
---|---|
Name: | ACADEMIC HOSPITALISTS MEDICAL GROUP |
Entity Type: | Organization |
Organization Name: | ACADEMIC HOSPITALISTS MEDICAL GROUP |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | VAIBHAV |
Authorized Official - Middle Name: | MADHUKAR |
Authorized Official - Last Name: | ANVEKAR |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 626-644-2343 |
Mailing Address - Street 1: | 50 BELLEFONTAINE ST |
Mailing Address - Street 2: | SUITE 307 |
Mailing Address - City: | PASADENA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 91105-3132 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 626-795-0411 |
Mailing Address - Fax: | 626-795-0080 |
Practice Address - Street 1: | 50 BELLEFONTAINE ST |
Practice Address - Street 2: | SUITE 307 |
Practice Address - City: | PASADENA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 91105-3132 |
Practice Address - Country: | US |
Practice Address - Phone: | 626-795-0411 |
Practice Address - Fax: | 626-795-0080 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-09-16 |
Last Update Date: | 2012-09-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Single Specialty |