Provider Demographics
NPI:1871730937
Name:TAWADROS, MAGED S
Entity type:Individual
Prefix:
First Name:MAGED
Middle Name:S
Last Name:TAWADROS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1183
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1183
Mailing Address - Country:US
Mailing Address - Phone:626-728-1708
Mailing Address - Fax:626-294-9414
Practice Address - Street 1:281 N ALTADENA DR # F
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3364
Practice Address - Country:US
Practice Address - Phone:626-728-1708
Practice Address - Fax:626-294-9414
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF 767522471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR0510016Medicare PIN