Healthcare Provider Details

I. General information

NPI: 1235389883
Provider Name (Legal Business Name): NORTHAMPTON RADIATION ONCOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 09/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LOCUST STREET, COOLEY DICKINSON HOSPITAL NORTHAMPTON RADIATION ONCOLOGY, LLC
NORTHAMPTON MA
01060
US

IV. Provider business mailing address

30 LOCUST STREET, COOLEY DICKINSON HOSPITAL NORTHAMPTON RADIATION ONCOLOGY, LLC
NORTHAMPTON MA
01060
US

V. Phone/Fax

Practice location:
  • Phone: 413-582-2107
  • Fax: 413-582-2963
Mailing address:
  • Phone: 413-582-2107
  • Fax: 413-582-2963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number77372
License Number StateMA

VIII. Authorized Official

Name: LINDA E. BORNSTEIN
Title or Position: OWNER
Credential: MD
Phone: 413-582-2107