Basic Information
| Provider Information | |||||||||
| NPI: | 1730152075 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID-PENN RADIATION ONCOLOGY LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4520 UNION DEPOSIT RD | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176526105 | ||||||||
| FaxNumber: | 7176522165 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 NORTH 3RD ST | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177824740 | ||||||||
| FaxNumber: | 7177824747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | NEWTON | ||||||||
| AuthorizedOfficialFirstName: | FREDERICK | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7177824740 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 | 0017883340003 | 05 | PA | MEDICAID |