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General NPI Number Information
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NPI Number | 1407912645
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Entity Type | Organization
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Legal Business Name | BERKSHIRE RADIATION ONCOLOGY PC
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Dates
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Enumeration Date | 12/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 725 NORTH ST
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City | PITTSFIELD
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State | MA
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Zip | 01201-4109
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Country | US
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Telephone | 413-447-2461
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Fax | 413-447-2461
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Provider Business Mailing Address
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Address Line | 725 NORTH ST
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City | PITTSFIELD
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State | MA
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Zip | 01201-4109
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Country | US
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Telephone | 413-447-2461
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Fax | 413-447-2461
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WADE J GEBARA
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Credential | MD
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Telephone | 413-447-2461
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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 | 209218
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License Number State | MA
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