Healthcare Provider Details

I. General information

NPI: 1417186297
Provider Name (Legal Business Name): GREENSBORO RADIATION ONCOLOGIST, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WENDOVER AVE STE 411
GREENSBORO NC
27401-1230
US

IV. Provider business mailing address

PO BOX 13921
GREENSBORO NC
27415-3921
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-3200
  • Fax: 336-482-2177
Mailing address:
  • Phone: 336-274-4285
  • Fax: 336-482-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW A MANNING
Title or Position: PRESIDENT
Credential: MD
Phone: 336-832-1100