Healthcare Provider Details

I. General information

NPI: 1134118342
Provider Name (Legal Business Name): MADISON RADIOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 N MADISON AVE LOWER LEVEL
PASADENA CA
91101-2035
US

IV. Provider business mailing address

223 N 1ST AVE SUITE #201
ARCADIA CA
91006-7089
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-8189
  • Fax: 626-795-3975
Mailing address:
  • Phone: 626-793-8189
  • Fax: 626-795-3975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TERRY BECKER
Title or Position: PRESIDENT OF MADISON RADIOLOGY
Credential: MEDICAL DOCTOR
Phone: 626-793-8189