Basic Information
| Provider Information | |||||||||
| NPI: | 1346665346 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIATION ONCOLOGY PHYSICIANS OF CONNECTICUT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 778 | ||||||||
| Address2: | 15 ENFORD STREET | ||||||||
| City: | AVON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060010778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604021090 | ||||||||
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| Practice Location | |||||||||
| Address1: | 326 WASHINGTON ST | ||||||||
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| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608898331 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2014 | ||||||||
| LastUpdateDate: | 02/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | KIM | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | Y | ||||||||
| AuthorizedOfficialTitleorPosition: | MD/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 8604021090 | ||||||||
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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 | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.