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Active Medical Licenses Report 2014

The document contains a list of medical providers including their name, degree, staff category, NPI number, license type, license number, license status, issue date, and expiration date. There are a total of 74 providers listed, most with active licenses issued between 2008-2014. Provider roles include physicians, nurses, dentists, and podiatrists working in specialties like telemedicine, courtesy, and affiliate positions.

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NVMC_ORIENTATION
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© Attribution Non-Commercial (BY-NC)
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Download as XLS, PDF, TXT or read online on Scribd
329 views4 pages

Active Medical Licenses Report 2014

The document contains a list of medical providers including their name, degree, staff category, NPI number, license type, license number, license status, issue date, and expiration date. There are a total of 74 providers listed, most with active licenses issued between 2008-2014. Provider roles include physicians, nurses, dentists, and podiatrists working in specialties like telemedicine, courtesy, and affiliate positions.

Uploaded by

NVMC_ORIENTATION
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
You are on page 1/ 4

Last Name

First Name

Degree

Staff Category

NPI

Lic Type

Lic Number

Kumar

Sandeep

MD

Telemedicine

1821031527

DEA

BK6659607

Farahmand

Arya

MD

Courtesy

1598751521

DEA

BF7218781

Garcia-Rivera

Ricardo

MD

Telemedicine

1366434334

DEA

AG1794634

Tran

Ann

MD

Telemedicine

1336133974

DEA

BT3244390

Yee

Hon

MD

Active

1851460679

DEA

AY9483633

Muz

Peter

MD

Active

1124006127

DEA

BM3305782

Salama

Magdy

MD

Active

1215918057

DEA

BS5645289

Sarkisyan

Alla

MD

Active

1326037508

DEA

BS7342885

Shore

Karen

MD

Affiliate

1699975672

DEA

FS2259035

Stecyk

Markian

MD

Courtesy

1679575617

DEA

BS1725108

Pongor

Paul

MD

Courtesy

1770585705

DEA

BP5711189

Resnick

Jeffrey

DPM

Active

1407822992

DEA

BR1968013

Wells

Joyce

NP

Allied Health

1457557175

DEA

MW0393746

Wong

William

MD

Telemedicine

1023093770

DEA

BW9022384

Allain

Rae

MD

Active

1700876699

DEA

BA4588147

Andreson

James

MD

Courtesy

1407867849

DEA

AA1724411

Aziz

Khalid

MD

Active

1538165055

DEA

BA3294369

Daye

Maureen

MD

Active

1316959026

DEA

BD4395162

Dressel

Jennifer

MD

Active

1447456348

DEA

FD2144183

Bacorro

Eugene

MD

Active

1659530137

DEA

FB2430382

Balser

Steven

MD

Active

1750468393

DEA

BB3552583

Barakat

Adbul

Rahman MD

Courtesy

1336102441

DEA

BB8780771

Bhat

Atul

Laxman

MD

Active

1144290222

DEA

BB7237072

Bown

Mark

MD

Affiliate

1710055447

DEA

AB1980540

Buxbaum

Robert

DMD

Active

1952386609

DEA

AB3112682

Chilukuri

Ananthakrishna

MD

Telemedicine

1245281997

DEA

FC0411962

Corrigan

Kelly

MD

Active

1275558488

DEA

BC8861191

Galvin

Hannah

MD

Active

1487855771

DEA

FG0835819

Giblin

Erica

MD

Affiliate

1063627479

DEA

FG0492479

Gillis

Zoe

MD

Active

1437174141

DEA

BG7712599

Gustafson

Craig

MD

Active Community

1780660845

DEA

BG5885782

Gutstein

Laurie

MD

Telemedicine

1538121116

DEA

BG1868427

Hangen

Donald

MD

Courtesy

1578565511

DEA

BH3562712

Hayes

Gerard

MD

Active

1942275169

DEA

BH3270965

Hendra

Katherine

DEA

BH3443900

Nathanson

Larry

MD

Active

1740220276

DEA

BN5993743

Tague

David

MD

Telemedicine

1841219508

DEA

BT0260074

Tangban

Neji

MD

Active

1790976629

DEA

FT0432194

Theoharis

Jennifer

MD

Telemedicine

1659356913

DEA

BT9047451

Report Date: 2/13/2014 5:46:11 PM

MI

H
M

Anne

Page 1 of 4

Thomas

Jancy

MD

Active

1457334187

DEA

BT9254169

Tomczak

Michal

MD

Active

1295909661

DEA

FT2205981

Jacob-Issac

Roshney

MD

Active

1710151584

DEA

FJ0981248

Jenis

Louis

MD

Courtesy

1285636993

DEA

BJ4806797

Johnson

Mark

MD

Active

1770518581

DEA

AJ1434430

Katzenberg

John

MD

Active

1265426076

DEA

AK2720185

Kiser

Randall

MD

Telemedicine

1366550477

DEA

BK4730037

Herzig

Gail

Marino

MD

Affiliate

1689608440

DEA

BM3603001

Moray

Jonathan

MD

Courtesy

1619964392

DEA

BM1061112

Murray

Scott

MD

Active

1265489991

DEA

BM9120180

Savage

Carol

MD

Active

1114909074

DEA

BS4819910

Schwartz

Richard

MD

Active

1053439844

DEA

AS7158834

Scott

Jordan

MD

Courtesy

1275517245

DEA

BS7936858

Searls

David

MD

Telemedicine

1386811032

DEA

FS0817025

Shih

Michael

MD

Active

1598747024

DEA

BS9243495

Simon

Gabriel

MD

Active

1366467086

DEA

BS9490967

SOMERS

ABA

Active

1245352319

DEA

FS0900440

Spencer

Terri

MD, MPH

Active

1568496222

DEA

BS9264312

Spiegelman

David

MD

Active

1083671952

DEA

AS7842328

Spinuzza

Thomas

MD

Telemedicine

1851388870

DEA

BS1062493

Stedman

George

MD

Active

1588683999

DEA

AS2772982

Sweet

Mitchell

MD

Active

1730149030

DEA

AS9388807

Sydlar

George

DMD

Active

1013139450

DEA

AS2241610

Report Date: 2/13/2014 5:46:11 PM

Page 2 of 4

License Status

Issue Date

Exp Date

Active

State

11/10/2008

12/31/2011

Active

9/18/2009

9/30/2012

Active

8/12/2009

9/30/2012

Active

10/26/2009

11/30/2012

Active

1/23/2013

Active

12/8/2009

1/31/2013

Active

12/31/2009

2/28/2013

Active

2/19/2010

2/28/2013

Active

9/24/2010

2/28/2013

Active

1/26/2010

2/28/2013

Active

3/3/2010

3/31/2013

3/2/2010

4/30/2013

Active

5/25/2010

5/31/2013

Active

4/21/2010

5/31/2013

Active

5/10/2010

6/30/2013

Active

6/3/2010

6/30/2013

Active

6/22/2010

6/30/2013

Active

5/8/2010

6/30/2013

Active

7/25/2010

6/30/2013

Active

2/11/2011

7/31/2013

Active

6/9/2010

7/31/2013

Active

6/9/2010

7/31/2013

Active

6/22/2010

7/31/2013

Active

6/29/2010

7/31/2013

Active

6/30/2010

7/31/2013

Active

8/25/2010

8/31/2013

Active

7/18/2010

8/31/2013

Active

8/1/2010

9/30/2013

Active

9/1/2010

9/30/2013

Active

9/2/2010

9/30/2013

Active

8/25/2010

9/30/2013

Active

8/20/2004

9/30/2013

Active

9/22/2010

10/31/2013

Active

9/21/2010

10/31/2013

9/2/2010

10/31/2013

Active

9/8/2010

10/31/2013

Active

11/11/2010

11/30/2013

Active

10/25/2010

11/30/2013

Active

11/3/2010

11/30/2013

Active

Active

MA

MA

Report Date: 2/13/2014 5:46:11 PM

Page 3 of 4

Active

11/11/2010

11/30/2013

Active

8/26/2010

11/30/2013

Active

12/15/2010

12/31/2013

Active

11/8/2010

12/31/2013

Active

11/22/2010

12/31/2013

Active

12/3/2010

12/31/2013

Active

12/10/2010

12/31/2013

Active

12/8/2010

1/31/2014

Active

12/17/2010

1/31/2014

Active

12/28/2010

1/31/2014

Active

2/16/2011

2/28/2014

Active

2/3/2011

2/28/2014

Active

1/13/2011

2/28/2014

Active

1/6/2011

2/28/2014

Active

1/3/2011

2/28/2014

1/15/2011

2/28/2014

2/19/2011

2/28/2014

Active

1/14/2011

2/28/2014

Active

1/13/2011

2/28/2014

Active

1/27/2011

2/28/2014

Active

1/21/2011

2/28/2014

Active

12/31/2010

2/28/2014

Active

1/23/2011

2/28/2014

Active
Active

MA

Report Date: 2/13/2014 5:46:11 PM

Page 4 of 4

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