Healthcare Provider Details

I. General information

NPI: 1508823568
Provider Name (Legal Business Name): BLUE RIDGE RADIATION ONCOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E GREENVILLE ST
ANDERSON SC
29621-1580
US

IV. Provider business mailing address

PO BOX 96803
CHARLOTTE NC
28296-6803
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-4600
  • Fax: 864-512-4621
Mailing address:
  • Phone: 864-512-4600
  • Fax: 864-512-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number11136
License Number StateSC

VIII. Authorized Official

Name: WILLIAM V TOMLINSON
Title or Position: MD
Credential: MD
Phone: 864-512-4600