Provider Demographics
NPI:1457586216
Name:EASTERN PENNSYLVANIA RADIATION ONCOLOGY PC
Entity type:Organization
Organization Name:EASTERN PENNSYLVANIA RADIATION ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOYLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-277-6812
Mailing Address - Street 1:15 ALLIANCE ST
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:17959-1101
Mailing Address - Country:US
Mailing Address - Phone:570-277-6218
Mailing Address - Fax:570-277-6398
Practice Address - Street 1:800 MAHONING ST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1246
Practice Address - Country:US
Practice Address - Phone:610-377-6881
Practice Address - Fax:610-377-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty