Provider Demographics
NPI:1861517245
Name:DUARTE RADIOLOGY MED GRP INC
Entity type:Organization
Organization Name:DUARTE RADIOLOGY MED GRP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-447-3926
Mailing Address - Street 1:159 E HUNTINGTON DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3224
Mailing Address - Country:US
Mailing Address - Phone:626-447-3926
Mailing Address - Fax:626-447-3717
Practice Address - Street 1:159 E HUNTINGTON DR
Practice Address - Street 2:SUITE 9
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3224
Practice Address - Country:US
Practice Address - Phone:626-447-3926
Practice Address - Fax:626-447-3717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G99990Medicaid
CA00G99990Medicaid
A90059Medicare UPIN