1790738102 NPI number — ADVANCED RADIATION ONCOLOGY ASSOCIATES, PC

Table of content: (NPI 1790738102)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790738102 NPI number — ADVANCED RADIATION ONCOLOGY ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED RADIATION ONCOLOGY ASSOCIATES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790738102
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 513029
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19175-3029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-709-3112
Provider Business Mailing Address Fax Number:
302-733-0854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 OSTRUM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18015-1000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-954-4300
Provider Business Practice Location Address Fax Number:
610-954-4671
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARDIGES
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
610-954-4300

Provider Taxonomy Codes

  • Taxonomy code: 2085R0203X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0018750460001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8870802 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH8569 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com