Provider Demographics
NPI:1740352723
Name:MAGORIEN, DAVID JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOSEPH
Last Name:MAGORIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 COFFEE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4201
Mailing Address - Country:US
Mailing Address - Phone:209-521-6097
Mailing Address - Fax:
Practice Address - Street 1:999 S FAIRMONT AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5100
Practice Address - Country:US
Practice Address - Phone:209-366-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41064207RC0000X, 207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060018902OtherRAILROAD MEDICARE
CAZZZ28052ZMedicare PIN
CAZZZ17828ZMedicare PIN
CAZZZ00967ZMedicare PIN
CA060018902OtherRAILROAD MEDICARE
CAZZZ00966ZMedicare PIN
CAGR0068233Medicaid
CAZZZ17828ZMedicare PIN
CAZZZ28052ZMedicare PIN
CAZZZ00968ZMedicare PIN
CAZZZ47673ZOtherBLUE SHIELD
CA00C410640Medicare ID - Type Unspecified
CAZZZ00965ZMedicare PIN
CAGR006823BMedicaid
CA00C410640Medicaid
CAGR0068230Medicaid
CAZZZ00967ZMedicare PIN
CAZZZ47674ZOtherBLUE SHIELD
CAGR0068232Medicaid
CAGR0068235Medicaid