Healthcare Provider Details

I. General information

NPI: 1407912645
Provider Name (Legal Business Name): BERKSHIRE RADIATION ONCOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 NORTH ST
PITTSFIELD MA
01201-4109
US

IV. Provider business mailing address

725 NORTH ST
PITTSFIELD MA
01201-4109
US

V. Phone/Fax

Practice location:
  • Phone: 413-447-2461
  • Fax: 413-447-2461
Mailing address:
  • Phone: 413-447-2461
  • Fax: 413-447-2461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number209218
License Number StateMA

VIII. Authorized Official

Name: DR. WADE J GEBARA
Title or Position: PRESIDENT
Credential: MD
Phone: 413-447-2461