Basic Information
| Provider Information | |||||||||
| NPI: | 1225010234 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRIC RADIATION ONCOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30560 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900300560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103354000 | ||||||||
| FaxNumber: | 3103354098 | ||||||||
| Practice Location | |||||||||
| Address1: | 470 JOHN YOUNG WAY | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105245550 | ||||||||
| FaxNumber: | 6105245546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | YELOVICH | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6105245550 | ||||||||
| 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 | 084362 | 01 | PA | BCBS PA | OTHER | 0121427000 | 01 | PA | KEYSTONE 65 | OTHER | 0121427000 | 01 | PA | KEYSTONE HEALTH PLAN EAST | OTHER | 0016763100002 | 05 | PA | MEDICAID | 0016763100003 | 05 | PA | MEDICAID | CG2734 | 01 | PA | RR MEDICARE | OTHER |