Healthcare Provider Details

I. General information

NPI: 1376588285
Provider Name (Legal Business Name): RADIATION ONCOLOGY GROUP OF WESTERN MA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LOCUST ST
NORTHAMPTON MA
01060-2052
US

IV. Provider business mailing address

291 MOODY ST
LUDLOW MA
01056-1246
US

V. Phone/Fax

Practice location:
  • Phone: 413-582-2963
  • Fax:
Mailing address:
  • Phone: 800-866-6663
  • Fax: 413-589-7554

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: ROBERT A. STEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 413-582-2963