MEDICARE: GETTYSBURG RADIATION ONCOLOGY

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	2085R0001X	Radiation Oncology Physician	AC2048862	PA

General Provider Information

NPI Number	:	1821315995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GETTYSBURG RADIATION ONCOLOGY

Provider Business Mailing Address
First Line	:	20 EXPEDITION TRAIL
Second Line	:	SUITE 100
City	:	GETTYSBURG
State	:	PA
Zip	:	17325
Country	:	US
Telephone Number	:	717-337-2101
Fax Number	:	717-334-5599

Provider Business Practice Location Address
First Line	:	20 EXPEDITION TRL
Second Line	:	SUITE 100
City	:	GETTYSBURG
State	:	PA
Zip	:	17325-8598
Country	:	US
Telephone Number	:	717-337-2101
Fax Number	:	717-334-5599

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	VINCENT CAPOSTAGNO
Credential	:	M.D.,
Telephone Number	:	717-337-2101

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	04/28/2010

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