Provider Demographics
NPI:1780622431
Name:MCFADDEN, GREGORY SMITH (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:SMITH
Last Name:MCFADDEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6207 STRESEMANN ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2124
Mailing Address - Country:US
Mailing Address - Phone:858-353-4671
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 970
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1234
Practice Address - Country:US
Practice Address - Phone:858-558-2731
Practice Address - Fax:858-452-5905
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG604372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A53590Medicare UPIN
CAW416Medicare PIN
CAWG60437AMedicare PIN