1508971284 NPI number — MICHAEL S REARDON,MD.INC.

Table of content: TAYLOR JACQUELINE MASOUD NP (NPI 1811554611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508971284 NPI number — MICHAEL S REARDON,MD.INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL S REARDON,MD.INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508971284
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 WELCH RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94304-1805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-617-8655
Provider Business Mailing Address Fax Number:
650-322-3416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 WELCH RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94304-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-617-8655
Provider Business Practice Location Address Fax Number:
650-322-3416
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REARDON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
650-617-8655

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  A30575 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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