Provider Demographics
NPI:1376546267
Name:RADIATION ONCOLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY ASSOCIATES INC
Other - Org Name:NORTHMAIN RADIATION ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICKLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:OLDENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-521-9700
Mailing Address - Street 1:825 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5707
Mailing Address - Country:US
Mailing Address - Phone:401-521-9700
Mailing Address - Fax:401-751-1686
Practice Address - Street 1:825 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5707
Practice Address - Country:US
Practice Address - Phone:401-521-9700
Practice Address - Fax:401-751-1686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9000233Medicaid
RICE6091OtherRR MEDICARE
RICE6091OtherRR MEDICARE
RI309000233Medicare PIN
RIG28567Medicare UPIN
RIB99129Medicare UPIN
RIH21239Medicare UPIN
RIE48445Medicare UPIN
RID87241Medicare UPIN