Provider Demographics
NPI:1104804889
Name:RADIATION MEDICINE SPECIALISTS OF NORTHEAST PENNSYLVANIA P C
Entity type:Organization
Organization Name:RADIATION MEDICINE SPECIALISTS OF NORTHEAST PENNSYLVANIA P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-714-8686
Mailing Address - Street 1:PO BOX 515490
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-6790
Mailing Address - Country:US
Mailing Address - Phone:310-335-4000
Mailing Address - Fax:
Practice Address - Street 1:190 WELLES ST
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4968
Practice Address - Country:US
Practice Address - Phone:570-714-8686
Practice Address - Fax:570-714-8666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2072453OtherAETNA USHC
PA1022318600001Medicaid
PA5170OtherGEISINGER HEALTH PLAN
PADN7304OtherRR MEDICARE
PA1022318600001Medicaid