Healthcare Provider Details

I. General information

NPI: 1184604266
Provider Name (Legal Business Name): RADIATION ONCOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE STE CC-101
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

PO BOX 1899
COLORADO SPRINGS CO
80901-1899
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-5281
  • Fax: 719-776-2525
Mailing address:
  • Phone: 719-570-7675
  • Fax: 719-471-9314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: DR. ANUJ V PEDDADA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 719-776-5281