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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740614130
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	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1918 W BEVERLY BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3957
Country	:	US
Telephone Number	:	323-838-6800
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SIDNEY FRIEDMAN
Credential	:	M.D.
Telephone Number	:	805-577-2011

Provider Enumeration Date	:	08/21/2013
Last Update Date	:	08/21/2013

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