Provider Demographics
NPI:1275629578
Name:PROSNITZ, ROBERT G (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:PROSNITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-0689
Mailing Address - Country:US
Mailing Address - Phone:814-237-8627
Mailing Address - Fax:814-238-0083
Practice Address - Street 1:1240 SOUTH CEDAR CREST BLVD
Practice Address - Street 2:RADIATION ONCOLOGY GROUND FLOOR
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18013-6248
Practice Address - Country:US
Practice Address - Phone:610-402-0700
Practice Address - Fax:610-402-0708
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2001-005952085R0001X
PAMD4359022085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129KHMedicaid
H41525Medicare UPIN
NC2289953Medicare ID - Type Unspecified