Healthcare Provider Details

I. General information

NPI: 1578741971
Provider Name (Legal Business Name): STARK RADIATION ONCOLOGY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PARK DR
DOVER OH
44622-2073
US

IV. Provider business mailing address

PO BOX 80468
CANTON OH
44708-0468
US

V. Phone/Fax

Practice location:
  • Phone: 330-454-2210
  • Fax: 330-454-9397
Mailing address:
  • Phone: 330-454-2210
  • Fax: 330-454-9397

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: PHILIP ALAN SCHNEIDER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-454-2210