Healthcare Provider Details

I. General information

NPI: 1477715407
Provider Name (Legal Business Name): DAVID LEONARD ANDOLINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 RIVERSIDE CIR RADIATION ONCOLOGY
EASTON PA
18045-5671
US

IV. Provider business mailing address

1600 RIVERSIDE CIR RADIATION ONCOLOGY
EASTON PA
18045-5671
US

V. Phone/Fax

Practice location:
  • Phone: 484-503-4400
  • Fax:
Mailing address:
  • Phone: 484-503-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD445249
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number25MA09148500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: