Provider Demographics
NPI:1982741435
Name:DREW, STANLEY IAN (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:IAN
Last Name:DREW
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 1:8510 BALBOA BLVD
Mailing Address - Street 2:SUITE 275
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-3583
Mailing Address - Country:US
Mailing Address - Phone:818-654-3400
Mailing Address - Fax:818-654-3411
Practice Address - Street 1:8510 BALBOA BLVD
Practice Address - Street 2:SUITE 275
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-3583
Practice Address - Country:US
Practice Address - Phone:818-654-3400
Practice Address - Fax:818-654-3411
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32935207R00000X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A329350Medicaid
CAWA32935AMedicare ID - Type Unspecified
CAA26979Medicare UPIN