Individual
DR. MANJUNATH S VADMAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2720 W MAGNOLIA BLVD, BURBANK, CA 91505-3034
(818) 842-8000
(323) 935-8804
Mailing address
8950 W OLYMPIC BLVD, SUITE 171, BEVERLY HILLS, CA 90211-3561
(323) 935-8800
(323) 935-8804
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
A73000
CA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
A73000
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A730000
BLUE SHIELD
CA
05
—
00A730000
—
CA
01
—
220031112
RAILROAD MEDICARE
CA
Enumeration date
08/04/2006
Last updated
12/31/2019
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