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General NPI Number Information
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NPI Number | 1790598787
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Entity Type | Organization
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Legal Business Name | CONNECTICUT PROTON THERAPY CENTER, LLC
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 932 NORTHOP ROAD
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City | WALLINGFORD
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State | CT
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Zip | 06492
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Country | US
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Telephone | 630-649-4060
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Fax | 312-896-9537
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Provider Business Mailing Address
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Address Line | 23472 N SANCTUARY CLUB DR
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City | KILDEER
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State | IL
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Zip | 60047-8626
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Country | US
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Telephone | 630-649-4060
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Fax | 312-896-9537
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. CHARLES YOO
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Credential |
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Telephone | 630-649-4060
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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