Healthcare Provider Details

I. General information

NPI: 1558358309
Provider Name (Legal Business Name): TOLEDO RADIATION ONCOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4841 MONROE ST SUITE 103
TOLEDO OH
43623-4385
US

IV. Provider business mailing address

4841 MONROE ST SUITE 103
TOLEDO OH
43623-4385
US

V. Phone/Fax

Practice location:
  • Phone: 419-471-0493
  • Fax: 419-472-2772
Mailing address:
  • Phone: 419-471-0493
  • Fax: 419-472-2772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TERRI G HENNING
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 419-471-0493