Provider Demographics
NPI:1861558173
Name:RICEBERG, EDWARD LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LAWRENCE
Last Name:RICEBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9400 BRIGHTON WAY
Mailing Address - Street 2:SUITE #201
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4714
Mailing Address - Country:US
Mailing Address - Phone:310-550-8028
Mailing Address - Fax:310-278-1570
Practice Address - Street 1:9400 BRIGHTON WAY
Practice Address - Street 2:SUITE #201
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4714
Practice Address - Country:US
Practice Address - Phone:310-550-8028
Practice Address - Fax:310-278-1570
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2008-12-12
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Provider Licenses
StateLicense IDTaxonomies
CAA22329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23020Medicare UPIN