Basic Information
| Provider Information | |||||||||
| NPI: | 1275629578 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PROSNITZ | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 689 | ||||||||
| Address2: | |||||||||
| City: | BOALSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168270689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142378627 | ||||||||
| FaxNumber: | 8142380083 | ||||||||
| Practice Location | |||||||||
| Address1: | 1240 SOUTH CEDAR CREST BLVD | ||||||||
| Address2: | RADIATION ONCOLOGY GROUND FLOOR | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180136248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104020700 | ||||||||
| FaxNumber: | 6104020708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 2001-00595 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | MD435902 | PA | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 89129KH | 05 | NC | MEDICAID |