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General NPI Number Information
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NPI Number | 1104145549
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Entity Type | Organization
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Legal Business Name | BEVERLY RADIOLOGY MEDICAL GROUP
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Dates
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Enumeration Date | 05/25/2010
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Last Update Date | 05/25/2010
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Provider Practice Location Address
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Address Line | 800 S CENTRAL AVE SUITE B
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City | GLENDALE
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State | CA
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Zip | 91204-4370
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Country | US
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Telephone | 310-445-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 800 S CENTRAL AVE SUITE B
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City | GLENDALE
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State | CA
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Zip | 91204-4370
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO & PRESIDENT
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Name | DR. HAROLD G. BERGER
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Credential | M.D.
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Telephone | 310-445-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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