Healthcare Provider Details

I. General information

NPI: 1063454783
Provider Name (Legal Business Name): 21ST CENTURY ONCOLOGY OF HARFORD COUNTY MARYLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BRASS MILL RD SUITE E
BELCAMP MD
21017-1217
US

IV. Provider business mailing address

2234 COLONIAL BLVD
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 410-272-9224
  • Fax: 410-575-7951
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

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: DAVID N.T. WATSON
Title or Position: CFO
Credential:
Phone: 239-931-7281