Provider Demographics
NPI:1811185804
Name:EMAD TADROS MD A PROF CORP
Entity Type:Organization
Organization Name:EMAD TADROS MD A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:G
Authorized Official - Last Name:TADROS MD A PROF CORP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-692-8118
Mailing Address - Street 1:4060 FOURTH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2120
Mailing Address - Country:US
Mailing Address - Phone:619-692-8118
Mailing Address - Fax:619-800-7385
Practice Address - Street 1:4060 FOURTH AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2120
Practice Address - Country:US
Practice Address - Phone:619-692-8118
Practice Address - Fax:619-800-7385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA495002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A495000Medicaid
CAW18489Medicare PIN