Provider Demographics
NPI:1962526194
Name:MYSTIC RADIATION ONCOLOGISTS, P.C.
Entity type:Organization
Organization Name:MYSTIC RADIATION ONCOLOGISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:HEIDBREDER
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:781-944-0008
Mailing Address - Street 1:113 EASTWAY
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-1110
Mailing Address - Country:US
Mailing Address - Phone:781-944-0008
Mailing Address - Fax:
Practice Address - Street 1:620 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1328
Practice Address - Country:US
Practice Address - Phone:781-944-0008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Single Specialty