Provider Demographics
NPI:1730105149
Name:GRIEDER, THOMAS ARTHUR (MD, PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ARTHUR
Last Name:GRIEDER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VAGLAHS- EAST LA PCT SUITE 150
Mailing Address - Street 2:5400 E OLYMPIC BLVD
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-5147
Mailing Address - Country:US
Mailing Address - Phone:323-725-7557
Mailing Address - Fax:323-725-7577
Practice Address - Street 1:VAGLAHS- EAST LA PCT SUITE 150
Practice Address - Street 2:5400 E OLYMPIC BLVD
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-5147
Practice Address - Country:US
Practice Address - Phone:323-725-7557
Practice Address - Fax:323-725-7577
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG708532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G708530OtherMEDICAL
CAG70853AMedicare ID - Type Unspecified
CAF58507Medicare UPIN