Healthcare Provider Details

I. General information

NPI: 1225010234
Provider Name (Legal Business Name): CENTRIC RADIATION ONCOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 JOHN YOUNG WAY SUITE 400
EXTON PA
19341
US

IV. Provider business mailing address

PO BOX 30560
LOS ANGELES CA
90030-0560
US

V. Phone/Fax

Practice location:
  • Phone: 610-524-5550
  • Fax: 610-524-5546
Mailing address:
  • Phone: 310-335-4000
  • Fax: 310-335-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: DR. RICHARD M YELOVICH
Title or Position: ADMINISTRATOR
Credential: MD
Phone: 610-524-5550