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NPI Code Detail

MEDICARE: RADIATION MEDICINE SERVICES, LLC

MEDICARE: RADIATION MEDICINE 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
12085R0001XRadiation Oncology Physician023574CT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1920007314OTHERCTRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588621726
Entity Type Code : Organization
Provider Name (Legal Business Name) : RADIATION MEDICINE SERVICES, LLC
Provider Business Mailing Address
First Line : PO BOX 10190
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23450-0190
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 80 SEYMOUR ST
Second Line :
City : HARTFORD
State : CT
Zip : 06106-3315
Country : US
Telephone Number : 860-545-2803
Fax Number :
Authorized Official
Title or Position : M.D.
Name : DR. JUDITH BUCKLEY
Credential :
Telephone Number : 860-545-2803
Provider Enumeration Date : 05/01/2006
Last Update Date : 06/27/2008

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