Healthcare Provider Details

I. General information

NPI: 1902887581
Provider Name (Legal Business Name): INTEGRATIVE RADIATION ONCOLOGY MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY
BERKELEY CA
94704
US

IV. Provider business mailing address

PO BOX 198939
ATLANTA GA
30384-8939
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-2462
  • Fax: 510-204-1499
Mailing address:
  • Phone: 770-693-2622
  • Fax: 770-693-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: PATRICK SWIFT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 510-204-2462