Provider Demographics
NPI:1588754410
Name:DARDEN, TED DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:DOUGLAS
Last Name:DARDEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14124 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342
Mailing Address - Country:US
Mailing Address - Phone:818-367-1012
Mailing Address - Fax:818-367-7570
Practice Address - Street 1:14124 FOOTHILL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342
Practice Address - Country:US
Practice Address - Phone:818-367-1012
Practice Address - Fax:818-367-7570
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-07-10
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Provider Licenses
StateLicense IDTaxonomies
CAA87457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A874570Medicaid
CA00A874570Medicaid
CAI48477Medicare UPIN
I48477Medicare UPIN