Provider Demographics
NPI:1215921044
Name:GIRSKY, MARC J (MD INC)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:J
Last Name:GIRSKY
Suffix:
Gender:M
Credentials:MD INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S GRAND AVE
Mailing Address - Street 2:SUITE 615
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3048
Mailing Address - Country:US
Mailing Address - Phone:213-748-0110
Mailing Address - Fax:213-748-0160
Practice Address - Street 1:1400 S GRAND AVE
Practice Address - Street 2:SUITE 615
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3048
Practice Address - Country:US
Practice Address - Phone:213-748-0110
Practice Address - Fax:213-748-0160
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83112207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00464615OtherMEDICARE RAILROAD
CA00G831120Medicaid
CA00G831120Medicaid
CAP00464615OtherMEDICARE RAILROAD