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NPI Code Detail

MEDICARE: MYSTIC RADIATION ONCOLOGISTS, P.C.

MEDICARE: MYSTIC RADIATION ONCOLOGISTS, P.C.
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
12085R0203XTherapeutic Radiology Physician

General Provider Information

NPI Number : 1962526194
Entity Type Code : Organization
Provider Name (Legal Business Name) : MYSTIC RADIATION ONCOLOGISTS, P.C.
Provider Business Mailing Address
First Line : 113 EASTWAY
Second Line :
City : READING
State : MA
Zip : 01867-1110
Country : US
Telephone Number : 781-944-0008
Fax Number :
Provider Business Practice Location Address
First Line : 620 WASHINGTON ST
Second Line :
City : WINCHESTER
State : MA
Zip : 01890-1328
Country : US
Telephone Number : 781-944-0008
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. RICHARD CHARLES HEIDBREDER
Credential : M. D.
Telephone Number : 781-944-0008
Provider Enumeration Date : 03/16/2007
Last Update Date : 08/22/2020

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