MEDICARE: JOHN GEORGE MARDIAT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	G44393	CA
2	2085R0204X	Vascular & Interventional Radiology Physician	G44393	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801896675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN GEORGE MARDIAT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 30820
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93130-0820
Country	:	US
Telephone Number	:	805-448-5825
Fax Number	:	805-569-0079

Provider Business Practice Location Address
First Line	:	316 W JUNIPERO ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-4305
Country	:	US
Telephone Number	:	805-448-5825
Fax Number	:	805-569-0079

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	01/25/2012

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