Provider Demographics
NPI:1962457812
Name:BEVERLY RADIOLOGY MEDICAL GROUP III
Entity Type:Organization
Organization Name:BEVERLY RADIOLOGY MEDICAL GROUP III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-445-2800
Mailing Address - Street 1:1510 COTNER AVE.
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3303
Mailing Address - Country:US
Mailing Address - Phone:310-445-2800
Mailing Address - Fax:310-479-1459
Practice Address - Street 1:1510 COTNER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3303
Practice Address - Country:US
Practice Address - Phone:310-445-2951
Practice Address - Fax:310-479-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATP018Medicare PIN
CATP054Medicare PIN
CAZZZ03726ZMedicare PIN
CATG256BMedicare PIN
CAW4653Medicare PIN
CAZZZ23616ZMedicare PIN
CATP051AMedicare PIN
CAW14186Medicare PIN
CATG053Medicare PIN
CAW16629Medicare PIN
CAZZZ15075ZMedicare PIN
CATG054Medicare PIN
CATG055Medicare PIN
CATP009Medicare PIN
CAW11335Medicare PIN
CAW16629CMedicare PIN
CATG056Medicare PIN
CATG256AMedicare PIN
CAW16629BMedicare PIN