Healthcare Provider Details

I. General information

NPI: 1164880571
Provider Name (Legal Business Name): REX RADIATION ONCOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 SUNNYBROOK RD
RALEIGH NC
27610-1827
US

IV. Provider business mailing address

117 SUNNYBROOK RD
RALEIGH NC
27610-1827
US

V. Phone/Fax

Practice location:
  • Phone: 919-334-3900
  • Fax: 919-250-9280
Mailing address:
  • Phone: 919-334-3900
  • Fax: 919-250-9280

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: BENJAMIN MATHEW
Title or Position: CFO
Credential:
Phone: 919-784-1440