Basic Information
| Provider Information | |||||||||
| NPI: | 1700865342 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID-HUDSON VALLEY RADIATION ONCOLOGY LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 171 TECHNOLOGY DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BOALSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168271635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142378627 | ||||||||
| FaxNumber: | 8142380083 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 READE PLACE | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126013947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454315645 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | PAPADOPOULOS | ||||||||
| AuthorizedOfficialFirstName: | DIMITRIOS | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8454315645 | ||||||||
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| 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 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0X00N60037 | 01 | NY | PHS HEALTHNET | OTHER | 70177 | 01 | NY | MVP | OTHER | CB1741 | 01 | NY | RR MEDICARE | OTHER | 01355540 | 05 | NY | MEDICAID | 0532398 | 01 | NY | AETNA USHC HMO | OTHER | 7065 | 01 | NY | CDPHP | OTHER |