=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568696474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MASSACHUSETTS ONCOLOGY SERVICES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2009
-----------------------------------------------------
Last Update Date | 05/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 HOSPITAL CENTER DRIVE
-----------------------------------------------------
City | HOLYOKE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01040-6601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-538-6868
-----------------------------------------------------
Fax | 413-538-6251
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2234 COLONIAL BLVD
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-1412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-931-7342
-----------------------------------------------------
Fax | 239-931-7385
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | DANIEL E. DOSORETZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 23993717275
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QX0203X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------