MEDICARE: EASTGATE 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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DF8293	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265541049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTGATE RADIATION ONCOLOGY LLC

Provider Business Mailing Address
First Line	:	PO BOX 10050
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90267-7550
Country	:	US
Telephone Number	:	310-335-4056
Fax Number	:	310-335-4098

Provider Business Practice Location Address
First Line	:	4415 AICHOLTZ RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1506
Country	:	US
Telephone Number	:	513-752-8100
Fax Number	:

Authorized Official
Title or Position	:	SENIOR VICE-PRESIDENT
Name	:	MARK SHALVARJIAN
Credential	:
Telephone Number	:	310-335-4056

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/09/2008

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Directions to “EASTGATE RADIATION ONCOLOGY LLC ” Practice Location

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