NPIMap

Individual provider Active NPI

Marie Therese Medawar, M.D.

  • Pediatric Adolescent Medicine Physician
  • Encino, CA
National Provider Identifier
1376621938
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
A44251 Issued in CA
Practice address
5353 Balboa Blvd
Suite 104
Encino, CA 91316-2804
Phone
(818) 789-7181
Fax
(818) 986-8322
NPI assigned
Nov 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X A44251 CA Primary

Addresses

Primary practice location

5353 Balboa Blvd
Suite 104
Encino, CA 91316-2804

Mailing address

5353 Balboa Blvd
Suite 104
Encino, CA 91316-2804
Phone (818) 789-7181

Other identifiers 1

IdentifierTypeStateIssuer
00A442510MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A44251CAMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tarzana Medical Center LLC Past Accepting new patients
Cedars-Sinai Medical Center Past Accepting new patients
Dignity Community Care Past Accepting new patients
Valley Pediatric Medical Group,Inc. Adolescent Medicine Past Accepting new patients
Valley Presbyterian Hospital Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1376621938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5353 BALBOA BLVD",
            "address_2": "SUITE 104",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913162804",
            "telephone_number": "818-789-7181",
            "fax_number": "818-986-8322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5353 BALBOA BLVD",
            "address_2": "SUITE 104",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913162804",
            "telephone_number": "818-789-7181",
            "fax_number": "818-986-8322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDAWAR",
        "first_name": "MARIE",
        "middle_name": "THERESE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CA",
            "license": "A44251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A442510",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Encino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.