Provider Demographics
NPI:1528067170
Name:FOLDVARY, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:FOLDVARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16580
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-2580
Mailing Address - Country:US
Mailing Address - Phone:310-271-3390
Mailing Address - Fax:
Practice Address - Street 1:3715 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805
Practice Address - Country:US
Practice Address - Phone:310-271-3390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-17
Last Update Date:2008-12-18
Deactivation Date:2005-07-18
Deactivation Code:
Reactivation Date:2007-06-19
Provider Licenses
StateLicense IDTaxonomies
CAG320262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G320261Medicaid
CAZZZ25745ZOtherBLUE SHIELD PROV NUMBER
CAG32026BMedicare PIN
C36031Medicare UPIN