MEDICARE: SCHENECTADY RADIATION ONCOLOGY LLC

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	:	1255323416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCHENECTADY RADIATION ONCOLOGY LLC

Provider Business Mailing Address
First Line	:	PO BOX 9036
Second Line	:	SCHENECTADY RADIATION ONCOLOGY LLC
City	:	SCHENECTADY
State	:	NY
Zip	:	12309-0036
Country	:	US
Telephone Number	:	518-243-4317
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 NOTT ST
Second Line	:	DEPT RADIATION ONCOLOGY
City	:	SCHENECTADY
State	:	NY
Zip	:	12308-2425
Country	:	US
Telephone Number	:	518-243-4317
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT J SMITH
Credential	:	MD
Telephone Number	:	518-243-4317

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	08/22/2020

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