Provider Demographics
NPI:1063469625
Name:RADIATION ONCOLOGY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:GABE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-425-1960
Mailing Address - Street 1:210 NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2136
Mailing Address - Country:US
Mailing Address - Phone:304-425-1960
Mailing Address - Fax:304-487-3514
Practice Address - Street 1:210 NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2136
Practice Address - Country:US
Practice Address - Phone:304-425-1960
Practice Address - Fax:304-487-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4000062000Medicaid
WVCM1605Medicare PIN
WV9244341Medicare ID - Type UnspecifiedMEDICARE GRP. NUMBER