Provider Demographics
NPI:1184893174
Name:GERALD M PAUL M D A MEDICAL CORPORATION
Entity type:Organization
Organization Name:GERALD M PAUL M D A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-996-6800
Mailing Address - Street 1:19147 MAYALL ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-1255
Mailing Address - Country:US
Mailing Address - Phone:818-996-6800
Mailing Address - Fax:818-996-2929
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:SUITE 614
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2804
Practice Address - Country:US
Practice Address - Phone:818-996-6800
Practice Address - Fax:818-996-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C35859Medicare UPIN
CAG13064Medicare PIN
CA5533740001Medicare NSC
CAW22158Medicare PIN