Healthcare Provider Details

I. General information

NPI: 1275629578
Provider Name (Legal Business Name): ROBERT G PROSNITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 SOUTH CEDAR CREST BLVD RADIATION ONCOLOGY GROUND FLOOR
ALLENTOWN PA
18013-6248
US

IV. Provider business mailing address

PO BOX 689
BOALSBURG PA
16827-0689
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-0700
  • Fax: 610-402-0708
Mailing address:
  • Phone: 814-237-8627
  • Fax: 814-238-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2001-00595
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD435902
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: