Provider Demographics
NPI:1659628758
Name:ROBERT A. MECUM, M.D., INC.
Entity Type:Organization
Organization Name:ROBERT A. MECUM, 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:A
Authorized Official - Last Name:MECUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-789-5577
Mailing Address - Street 1:12291 WASHINGTON BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-2551
Mailing Address - Country:US
Mailing Address - Phone:562-789-5577
Mailing Address - Fax:562-789-5567
Practice Address - Street 1:1605 EUSTON RD
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-1917
Practice Address - Country:US
Practice Address - Phone:562-789-5577
Practice Address - Fax:562-789-5567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78258207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G782580Medicaid
CAG15084Medicare UPIN