Provider Demographics
NPI:1760661110
Name:THOMAS A HERBOLD MD A PROFETIONAL CORP
Entity Type:Organization
Organization Name:THOMAS A HERBOLD MD A PROFETIONAL CORP
Other - Org Name:DISC RADIOLOGY MEDICAL CENTER, PROFESSIONAL CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANDY
Authorized Official - Last Name:HERBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-986-3472
Mailing Address - Street 1:16661 VENTURA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1914
Mailing Address - Country:US
Mailing Address - Phone:818-986-3472
Mailing Address - Fax:818-670-7789
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1914
Practice Address - Country:US
Practice Address - Phone:818-986-3472
Practice Address - Fax:818-760-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty