Provider Demographics
NPI:1134203847
Name:MARSHALL E. REDDING, MD, INC.
Entity type:Organization
Organization Name:MARSHALL E. REDDING, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:E
Authorized Official - Last Name:REDDING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-595-1656
Mailing Address - Street 1:2530 ATLANTIC AVE
Mailing Address - Street 2:#B
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2741
Mailing Address - Country:US
Mailing Address - Phone:562-595-1656
Mailing Address - Fax:562-595-4270
Practice Address - Street 1:2530 ATLANTIC AVE
Practice Address - Street 2:#B
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2741
Practice Address - Country:US
Practice Address - Phone:562-595-1656
Practice Address - Fax:562-595-4270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0048960Medicaid
CAGR0048960Medicaid