Basic Information
| Provider Information | |||||||||
| NPI: | 1114906856 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PENN VIEW RADIATION ONCOLOGY, LTD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PENN VIEW RADIATION ONCOLOGY | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 892 | ||||||||
| Address2: | |||||||||
| City: | CONCORDVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193310892 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664123192 | ||||||||
| FaxNumber: | 6103723735 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 HORIZON DR | ||||||||
| Address2: | |||||||||
| City: | CHALFONT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189143967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8664123192 | ||||||||
| FaxNumber: | 6103723735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 11/06/2007 | ||||||||
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| AuthorizedOfficialLastName: | HIGHTOWER | ||||||||
| AuthorizedOfficialFirstName: | MARTIN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2158229062 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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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 | 0018273990005 | 05 | PA | MEDICAID |