Healthcare Provider Details

I. General information

NPI: 1316939440
Provider Name (Legal Business Name): WYOMING VALLEY RADIATION MEDICINE SPECIALISTS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 N RIVER ST
WILKES BARRE PA
18764-0999
US

IV. Provider business mailing address

50 ROOSEVELT TER
WILKES BARRE PA
18702-3517
US

V. Phone/Fax

Practice location:
  • Phone: 570-552-1300
  • Fax: 570-552-1498
Mailing address:
  • Phone: 570-822-9822
  • Fax: 570-822-7955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT A ROSTOCK
Title or Position: DIRECTOR
Credential: MD
Phone: 570-552-1300