Basic Information
| Provider Information | |||||||||
| NPI: | 1710917968 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RADIATION ONCOLOGISTS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12870 | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198502870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027094487 | ||||||||
| FaxNumber: | 3027092413 | ||||||||
| Practice Location | |||||||||
| Address1: | RADIATION ONCOLOGISTS PA | ||||||||
| Address2: | 4701 OGLETOWN-STANTON ROAD | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197132055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027330806 | ||||||||
| FaxNumber: | 3027330854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 08/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | STRASSER | ||||||||
| AuthorizedOfficialFirstName: | JON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3026234824 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 2085R0001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 0018314530001 | 05 | PA | MEDICAID | 0000162002 | 05 | DE | MEDICAID | ========= | 01 | DE | TAX ID | OTHER | 967731301 | 05 | MD | MEDICAID |