Healthcare Provider Details

I. General information

NPI: 1457337719
Provider Name (Legal Business Name): RADIATION ONCOLOGY ASSOCIATES P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 W JEFFERSON BLVD STE 110
FORT WAYNE IN
46804-4159
US

IV. Provider business mailing address

7910 W JEFFERSON BLVD STE. 110
FORT WAYNE IN
46804-4159
US

V. Phone/Fax

Practice location:
  • Phone: 260-436-4116
  • Fax:
Mailing address:
  • Phone: 260-436-4116
  • Fax: 260-459-2504

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: NANETTE J ISENBARGER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 260-918-2701