Provider Demographics
NPI:1407912645
Name:BERKSHIRE RADIATION ONCOLOGY PC
Entity Type:Organization
Organization Name:BERKSHIRE RADIATION ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GEBARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-447-2461
Mailing Address - Street 1:725 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4109
Mailing Address - Country:US
Mailing Address - Phone:413-447-2461
Mailing Address - Fax:413-447-2461
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4109
Practice Address - Country:US
Practice Address - Phone:413-447-2461
Practice Address - Fax:413-447-2461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2092182085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA28223OtherHEALTH NEW ENGLAND
MA1007786Medicaid
MA9714677OtherMASS HEALTH PROVIDER
MA463389OtherTUFTS
MA01813203Medicaid
MA000000023752OtherMASS HEALTH NET PROVIDER
MA28223OtherHEALTH NEW ENGLAND
MA01813203Medicaid