Provider Demographics
NPI:1740442045
Name:ANAHEIM RADIOLOGY MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:ANAHEIM RADIOLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:HERWITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-339-1514
Mailing Address - Street 1:3105 PASEO DEL CAMPO
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-1034
Mailing Address - Country:US
Mailing Address - Phone:310-375-8170
Mailing Address - Fax:310-375-8176
Practice Address - Street 1:3105 PASEO DEL CAMPO
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-1034
Practice Address - Country:US
Practice Address - Phone:310-339-1514
Practice Address - Fax:310-375-8176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG236692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0009701Medicaid
CAHW1596AMedicare PIN