Basic Information
| Provider Information | |||||||||
| NPI: | 1952674079 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOX CHASE CANCER CENTER MEDICAL GROUP, INC | ||||||||
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| OtherOrganizationName: | PINNACLE RADONC OF FCCC, MGI | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 COTTMAN AVE | ||||||||
| Address2: | MSO/ENROLMENT | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191112434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157286900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4300 LONDONDERRY RD | ||||||||
| Address2: | MEDICAL SCIENCE PAV -STE 201 | ||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171095317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177246760 | ||||||||
| FaxNumber: | 7177246761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2012 | ||||||||
| LastUpdateDate: | 02/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | BECK | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VP | ||||||||
| AuthorizedOfficialTelephone: | 2152141409 | ||||||||
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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 | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.