Provider Demographics
NPI:1649206194
Name:MAGRAM, GARY (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:MAGRAM
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 1:9300 VALLEY CHILDRENS PL
Mailing Address - Street 2:CHILDREN'S HOSPITAL CENTRAL CALIFORNIA, NEUROSURGERY
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8761
Mailing Address - Country:US
Mailing Address - Phone:559-353-6277
Mailing Address - Fax:559-353-5424
Practice Address - Street 1:9300 VALLEY CHILDRENS PL
Practice Address - Street 2:CHILDREN'S HOSPITAL CENTRAL CALIFORNIA, NEUROSURGERY
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8761
Practice Address - Country:US
Practice Address - Phone:559-353-6277
Practice Address - Fax:559-353-5424
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52784207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD01317Medicare UPIN