Provider Demographics
NPI:1780639914
Name:MADDEN, BRIAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:MADDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1821 WILSHIRE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5627
Mailing Address - Country:US
Mailing Address - Phone:310-575-3100
Mailing Address - Fax:310-575-3102
Practice Address - Street 1:2021 SANTA MONICA BLVD STE 245E
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2132
Practice Address - Country:US
Practice Address - Phone:310-829-8975
Practice Address - Fax:424-291-4108
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70323207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0091750Medicaid
CAH37887Medicare UPIN
CAWA70323AMedicare ID - Type Unspecified