Healthcare Provider Details

I. General information

NPI: 1518959097
Provider Name (Legal Business Name): LUCIAN MAIDAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 09/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 Q ST
SACRAMENTO CA
95816-7058
US

IV. Provider business mailing address

3000 Q ST
SACRAMENTO CA
95816-7058
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-5779
  • Fax: 916-733-5743
Mailing address:
  • Phone: 916-733-5779
  • Fax: 916-733-5743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License NumberA55183
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberA55183
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA55183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: