Basic Information
| Provider Information | |||||||||
| NPI: | 1184604266 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIATION ONCOLOGY, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1899 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809011899 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195707675 | ||||||||
| FaxNumber: | 7194719314 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 N NEVADA AVE STE CC-101 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809076819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7197765281 | ||||||||
| FaxNumber: | 7197762525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 02/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | PEDDADA | ||||||||
| AuthorizedOfficialFirstName: | ANUJ | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7197765281 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 02/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 04008348 | 05 | CO | MEDICAID |