Organization
PEDIATRIC IMAGING MEDICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD COHEN MD (PRESIDENT)
(510) 428-3410
Entity
Organization
Contact information
Practice address
747 52ND ST, OAKLAND, CA 94609-1809
(510) 428-3410
(510) 601-3968
Mailing address
PO BOX 6102, NOVATO, CA 94948-6102
(415) 884-3404
(415) 883-1836
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100504919
—
NV
05
—
GR0094540
—
CA
01
—
ZZZ09080Z
BLUE SHIELD OF CA
CA
Enumeration date
05/25/2006
Last updated
04/15/2015
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