Healthcare Provider Details

I. General information

NPI: 1821465642
Provider Name (Legal Business Name): VIDANT RADIATION ONCOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 MOYE BOULEVARD
GREENVILLE NC
27834-2818
US

IV. Provider business mailing address

1419 SE 8TH TER STE 200
CAPE CORAL FL
33990-3213
US

V. Phone/Fax

Practice location:
  • Phone: 252-551-6300
  • Fax: 252-551-6391
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: SHADEN MARZOUK
Title or Position: PRESIDENT
Credential:
Phone: 239-931-7254