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NPI Code Detail

MEDICARE: TD ONCOLOGY SERVICES LLC

MEDICARE: TD ONCOLOGY SERVICES 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
1261QX0203XRadiation Oncology Clinic/Center

General Provider Information

NPI Number : 1326368929
Entity Type Code : Organization
Provider Name (Legal Business Name) : TD ONCOLOGY SERVICES LLC
Provider Business Mailing Address
First Line : PO BOX 10050
Second Line :
City : MANHATTAN BEACH
State : CA
Zip : 90267-7550
Country : US
Telephone Number : 310-335-4000
Fax Number : 310-335-4098
Provider Business Practice Location Address
First Line : 2452 KIPLING AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45239-6650
Country : US
Telephone Number : 513-681-7800
Fax Number : 513-853-3045
Authorized Official
Title or Position : SENIOR VP
Name : MARK SHALVARJIAN
Credential :
Telephone Number : 310-335-4008
Provider Enumeration Date : 06/04/2010
Last Update Date : 06/04/2010

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