=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063446086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRAND VIEW RADIATION ONCOLOGY, LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2006
-----------------------------------------------------
Last Update Date | 11/15/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 LAWN AVE
-----------------------------------------------------
City | SELLERSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18960-1548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-453-4950
-----------------------------------------------------
Fax | 215-453-4094
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 LAWN AVE
-----------------------------------------------------
City | SELLERSVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18960-1548
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-453-4950
-----------------------------------------------------
Fax | 215-453-4094
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. MARTIN C. HIGHTOWER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 215-453-4950
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | 042039E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------