Provider Demographics
NPI:1972595528
Name:TONNEMACHER, DAVID PAUL (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:TONNEMACHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 S CENTRAL AVE
Mailing Address - Street 2:610
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2500
Mailing Address - Country:US
Mailing Address - Phone:818-243-2179
Mailing Address - Fax:818-243-2263
Practice Address - Street 1:1510 S CENTRAL AVE
Practice Address - Street 2:610
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2500
Practice Address - Country:US
Practice Address - Phone:818-243-2179
Practice Address - Fax:818-243-2263
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42261207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASTATE LIC; G42261OtherCA. STATE LICENSE
CAG42261Medicaid
CAA48886Medicare UPIN
CASTATE LIC; G42261OtherCA. STATE LICENSE