MEDICARE: PETER FOLDVARY MD A PROFESSIONAL CORPORATION

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	G32026	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ25745Z	OTHER	CA	BLUE SHIELD PROV NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760481907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER FOLDVARY MD A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 16580
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90209-2580
Country	:	US
Telephone Number	:	310-271-3390
Fax Number	:

Provider Business Practice Location Address
First Line	:	3715 E SOUTH ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-4521
Country	:	US
Telephone Number	:	310-271-3390
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETER FOLDVARY
Credential	:	MD
Telephone Number	:	310-271-3390

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	08/23/2023

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