Basic Information
| Provider Information | |||||||||
| NPI: | 1376588285 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIATION ONCOLOGY GROUP OF WESTERN MA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 291 MOODY ST | ||||||||
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| City: | LUDLOW | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010561246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008666663 | ||||||||
| FaxNumber: | 4135897554 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135822963 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | STEIN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4135822963 | ||||||||
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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 | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.