Organization
MADISON RADIOLOGY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRY BECKER MEDICAL DOCTOR (PRESIDENT OF MADISON RADIOLOGY)
(626) 793-8189
Entity
Organization
Contact information
Practice address
65 N MADISON AVE, LOWER LEVEL, PASADENA, CA 91101-2035
(626) 793-8189
(626) 795-3975
Mailing address
223 N 1ST AVE, SUITE #201, ARCADIA, CA 91006-7089
(626) 793-8189
(626) 795-3975
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0079230
—
CA
01
—
ZZZ56942Z
BLUE SHIELD
CA
Enumeration date
10/19/2005
Last updated
03/08/2019
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