Healthcare Provider Details

I. General information

NPI: 1891737508
Provider Name (Legal Business Name): HAVERTOWN RADIOSURGERY CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 W CHESTER PIKE SUITE 115
HAVERTOWN PA
19083-2700
US

IV. Provider business mailing address

2010 W CHESTER PIKE SUITE 115
HAVERTOWN PA
19083-2700
US

V. Phone/Fax

Practice location:
  • Phone: 610-446-6850
  • Fax: 610-446-6852
Mailing address:
  • Phone: 610-446-6850
  • Fax: 610-446-6852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License NumberAC20-48878
License Number StatePA

VIII. Authorized Official

Name: DR. LUTHER WELDON BRADY JR.
Title or Position: CO-OWNER
Credential: M.D.
Phone: 610-446-6850