Provider Demographics
NPI:1558363416
Name:LADENHEIM, MARC L (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:L
Last Name:LADENHEIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2701 W ALAMEDA AVE
Mailing Address - Street 2:STE 607
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4411
Mailing Address - Country:US
Mailing Address - Phone:818-846-3201
Mailing Address - Fax:818-846-3939
Practice Address - Street 1:2701 W ALAMEDA AVE
Practice Address - Street 2:STE 607
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4411
Practice Address - Country:US
Practice Address - Phone:818-846-3201
Practice Address - Fax:818-846-3939
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2016-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG049875207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G498751Medicaid
CAHW7714Medicare PIN
CAG49875Medicare ID - Type Unspecified
CA00G498751Medicaid