Provider Demographics
NPI:1457337719
Name:RADIATION ONCOLOGY ASSOCIATES P C
Entity type:Organization
Organization Name:RADIATION ONCOLOGY ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ISENBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-918-2701
Mailing Address - Street 1:7910 W JEFFERSON BLVD
Mailing Address - Street 2:STE. 110
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4159
Mailing Address - Country:US
Mailing Address - Phone:260-436-4116
Mailing Address - Fax:260-459-2504
Practice Address - Street 1:7910 W JEFFERSON BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4159
Practice Address - Country:US
Practice Address - Phone:260-436-4116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0533239Medicaid
IN100257820AMedicaid
OH0533239Medicaid
IN100257820AMedicaid
INCM9721OtherMEDICARE RAILROAD