Healthcare Provider Details

I. General information

NPI: 1508042201
Provider Name (Legal Business Name): NEWBERRY ONCOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 COMMERCE DR.
NEWBERRY SC
29108
US

IV. Provider business mailing address

298 COMMERCE DR.
NEWBERRY SC
29108
US

V. Phone/Fax

Practice location:
  • Phone: 803-321-3232
  • Fax:
Mailing address:
  • Phone: 803-321-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number12631
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number21440
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD8174
License Number StateSC

VIII. Authorized Official

Name: DR. STEVEN A MADDEN
Title or Position: MBR
Credential: M.D.
Phone: 803-321-3232