MEDICARE: SOUTH SURBURBAN ONCOLOGY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician

General Provider Information

NPI Number	:	1043492846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH SURBURBAN ONCOLOGY

Provider Business Mailing Address
First Line	:	55 CHRISTY DR
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-1813
Country	:	US
Telephone Number	:	508-897-1505
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 CHRISTY DR
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-1813
Country	:	US
Telephone Number	:	508-897-1505
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. HAROLD JOSEPH BARTHOLD
Credential	:	MD
Telephone Number	:	508-897-1505

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	12/04/2007

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