Provider Demographics
NPI:1346665346
Name:RADIATION ONCOLOGY PHYSICIANS OF CONNECTICUT, LLC
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY PHYSICIANS OF CONNECTICUT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-402-1090
Mailing Address - Street 1:PO BOX 778
Mailing Address - Street 2:15 ENFORD STREET
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-0778
Mailing Address - Country:US
Mailing Address - Phone:860-402-1090
Mailing Address - Fax:
Practice Address - Street 1:326 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2740
Practice Address - Country:US
Practice Address - Phone:860-889-8331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty