Provider Demographics
NPI:1861035495
Name:MICHAEL T LARDON MD APC
Entity Type:Organization
Organization Name:MICHAEL T LARDON MD APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:LARDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-292-2929
Mailing Address - Street 1:3750 CONVOY ST STE 318
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3741
Mailing Address - Country:US
Mailing Address - Phone:858-292-2929
Mailing Address - Fax:858-292-2909
Practice Address - Street 1:3750 CONVOY ST STE 318
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3741
Practice Address - Country:US
Practice Address - Phone:858-292-2929
Practice Address - Fax:858-292-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-27
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty