Healthcare Provider Details

I. General information

NPI: 1366766180
Provider Name (Legal Business Name): BEVERLY RADIOLOGY MEDICAL GROUP III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 W ALAMEDA AVE STE 101
BURBANK CA
91505-4810
US

IV. Provider business mailing address

2601 W ALAMEDA AVE STE 101
BURBANK CA
91505-4810
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-7462
  • Fax:
Mailing address:
  • Phone: 818-843-7462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG19870
License Number StateCA

VIII. Authorized Official

Name: DR. HOWARD G. BERGER
Title or Position: CEO & PRESIDENT
Credential: M.D.
Phone: 310-445-2800