Provider Demographics
NPI:1043492846
Name:SOUTH SURBURBAN ONCOLOGY
Entity Type:Organization
Organization Name:SOUTH SURBURBAN ONCOLOGY
Other - Org Name:SOUTH SURBURBAN ONCOLOGY DOCTORS
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BARTHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-897-1505
Mailing Address - Street 1:55 CHRISTY DR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1813
Mailing Address - Country:US
Mailing Address - Phone:508-897-1505
Mailing Address - Fax:
Practice Address - Street 1:55 CHRISTY DR
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1813
Practice Address - Country:US
Practice Address - Phone:508-897-1505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH SURBURBAN ONCOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty