MEDICARE: INTENSITY MODULATED RADIATION THERAPY ASSOCIATES P C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649279241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTENSITY MODULATED RADIATION THERAPY ASSOCIATES P C

Provider Business Mailing Address
First Line	:	PO BOX 62254
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-2254
Country	:	US
Telephone Number	:	570-451-3910
Fax Number	:	570-451-3236

Provider Business Practice Location Address
First Line	:	231 E BROWN ST
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-3005
Country	:	US
Telephone Number	:	570-476-3488
Fax Number	:	570-476-3473

Authorized Official
Title or Position	:	RADIATION ONCOLOGIST
Name	:	MICHAEL J. GREENBERG
Credential	:	M.D.
Telephone Number	:	570-476-3488

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	06/13/2008

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