MEDICARE: HAWTHORNE RADIOLOGY ASSOCIATES MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1427002856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAWTHORNE RADIOLOGY ASSOCIATES MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	PO BOX 190
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93062-0190
Country	:	US
Telephone Number	:	805-522-5940
Fax Number	:	805-522-6401

Provider Business Practice Location Address
First Line	:	1918 W BEVERLY BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3957
Country	:	US
Telephone Number	:	800-965-0483
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	SIDNEY FRIEDMAN
Credential	:	M.D.
Telephone Number	:	323-932-5301

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	07/16/2015

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