Healthcare Provider Details

I. General information

NPI: 1891086096
Provider Name (Legal Business Name): RADIATION THERAPY ASSOCIATES OF WESTERN NORTH CAROLINA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date: 07/11/2019
Reactivation Date: 07/19/2019

III. Provider practice location address

141 TRYON RD SUITE B
RUTHERFORDTON NC
28139-3099
US

IV. Provider business mailing address

2234 COLONIAL BLVD
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 828-286-1445
  • Fax: 828-286-1443
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY D. SHAFMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 401-456-2690