Provider Demographics
NPI:1952465635
Name:MUDRIC TIGANU, BRINDUSA DANA (MD)
Entity Type:Individual
Prefix:MRS
First Name:BRINDUSA
Middle Name:DANA
Last Name:MUDRIC TIGANU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W. HUNTINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007
Mailing Address - Country:US
Mailing Address - Phone:626-514-3442
Mailing Address - Fax:626-574-3592
Practice Address - Street 1:300 W. HUNTINGTON DRIVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007
Practice Address - Country:US
Practice Address - Phone:203-276-7000
Practice Address - Fax:203-276-7366
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044413207R00000X, 208M00000X
NY222260208M00000X
CAC52392208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2239774Medicaid
NYH58726Medicare UPIN