Healthcare Provider Details

I. General information

NPI: 1306893458
Provider Name (Legal Business Name): DELAWARE RADIATION ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

793 S QUEEN ST
DOVER DE
19904-3568
US

IV. Provider business mailing address

PO BOX 441
DOVER DE
19903-0441
US

V. Phone/Fax

Practice location:
  • Phone: 414-455-4780
  • Fax:
Mailing address:
  • Phone: 414-455-4780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN LAHANIATIS
Title or Position: PRESIDENT
Credential:
Phone: 302-674-4401