Healthcare Provider Details

I. General information

NPI: 1316999337
Provider Name (Legal Business Name): EASTGATE CANCER CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 AICHOLTZ RD
CINCINNATI OH
45245-1506
US

IV. Provider business mailing address

PO BOX 10050
MANHATTAN BEACH CA
90267-7550
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-8100
  • Fax:
Mailing address:
  • Phone: 310-335-4056
  • Fax:

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: WAGIH SHEHATA
Title or Position: MD, CEO
Credential: MD
Phone: 513-752-8100