Provider Demographics
NPI:1881617736
Name:NUDELL, GARY HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:HOWARD
Last Name:NUDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:23101 SHERMAN PLACE
Mailing Address - Street 2:510
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307
Mailing Address - Country:US
Mailing Address - Phone:818-676-4806
Mailing Address - Fax:818-676-4820
Practice Address - Street 1:23101 SHERMAN PL
Practice Address - Street 2:510
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2003
Practice Address - Country:US
Practice Address - Phone:818-676-4806
Practice Address - Fax:818-676-4820
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA64512207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG94219Medicare UPIN
CAA64512Medicare ID - Type Unspecified