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NPI Code Detail

MEDICARE: DR. JAY B MADHURE M.D.

MEDICARE: DR. JAY B MADHURE 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
1207QA0000XAdolescent Medicine (Family Medicine) PhysicianA33612CA

Other Identifiers

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

General Provider Information

NPI Number : 1770518714
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAY B MADHURE M.D.
Provider Business Mailing Address
First Line : 16281 SAN FERNANDO MISSION BLVD
Second Line :
City : GRANADA HILLS
State : CA
Zip : 91344-3725
Country : US
Telephone Number : 818-838-4600
Fax Number : 818-366-7479
Provider Business Practice Location Address
First Line : 16281 SAN FERNANDO MISSION BLVD
Second Line :
City : GRANADA HILLS
State : CA
Zip : 91344-3725
Country : US
Telephone Number : 818-838-4600
Fax Number : 818-366-7479
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 08/20/2016

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