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General NPI Number Information
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NPI Number | 1386832129
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Entity Type | Organization
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Legal Business Name | EASTERN SHORE RADIATION ONCOLOGY ASSOC., P.A.
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 05/22/2018
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Provider Practice Location Address
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Address Line | 509 IDLEWILD AVE
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City | EASTON
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State | MD
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Zip | 21601
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Country | US
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Telephone | 410-820-6411
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Fax | 410-820-4229
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Provider Business Mailing Address
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Address Line | 509 IDLEWILD AVE
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City | EASTON
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State | MD
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Zip | 21601-3889
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Country | US
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Telephone | 410-820-6411
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Fax | 410-820-4229
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN PHILIP MASTANDREA
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Credential | M.D.
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Telephone | 410-820-6411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | D0036644
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License Number State | MD
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