Basic Information
| Provider Information | |||||||||
| NPI: | 1104804889 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIATION MEDICINE SPECIALISTS OF NORTHEAST PENNSYLVANIA P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 515490 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900516790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103354000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 190 WELLES ST | ||||||||
| Address2: | |||||||||
| City: | FORTY FORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187044968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5707148686 | ||||||||
| FaxNumber: | 5707148666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | SCHULMAN | ||||||||
| AuthorizedOfficialFirstName: | NORMAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5707148686 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 2072453 | 01 | PA | AETNA USHC | OTHER | 1022318600001 | 05 | PA | MEDICAID | 5170 | 01 | PA | GEISINGER HEALTH PLAN | OTHER | DN7304 | 01 | PA | RR MEDICARE | OTHER |