MEDICARE: ARA A. POLADIAN, M.D.,FACOG,PROFESSIONAL CORPORATION

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	305R00000X	Preferred Provider Organization	A40162	CA

General Provider Information

NPI Number	:	1801161047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARA A. POLADIAN, M.D.,FACOG,PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	10876 RIVERSIDE DR
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2236
Country	:	US
Telephone Number	:	818-763-2992
Fax Number	:	818-763-6054

Provider Business Practice Location Address
First Line	:	10876 RIVERSIDE DR
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-2236
Country	:	US
Telephone Number	:	818-763-2992
Fax Number	:	818-763-6054

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ARA A POLADIAN
Credential	:	M.D.
Telephone Number	:	818-763-2992

Provider Enumeration Date	:	03/21/2012
Last Update Date	:	04/11/2012

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