Provider Demographics
NPI:1215078381
Name:GIRARD, PHILIP MARIUS JR (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MARIUS
Last Name:GIRARD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PHILIP
Other - Middle Name:MARIUS
Other - Last Name:GIRARD
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:425 S FAIR OAKS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2632
Mailing Address - Country:US
Mailing Address - Phone:626-449-1814
Mailing Address - Fax:626-449-0007
Practice Address - Street 1:425 S FAIR OAKS AVE STE A
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2632
Practice Address - Country:US
Practice Address - Phone:626-449-1814
Practice Address - Fax:626-449-0007
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG328122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G328120OtherBLUE SHIELD
CA130000099OtherMEDICARE RR
CA00G328120Medicaid
CA00G328120OtherBLUE SHIELD