Provider Demographics
NPI:1417392499
Name:UPPER CHESAPEAKE RADIATION ONCOLOGY, LLC
Entity Type:Organization
Organization Name:UPPER CHESAPEAKE RADIATION ONCOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:443-643-3340
Mailing Address - Street 1:500 UPPER CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4324
Mailing Address - Country:US
Mailing Address - Phone:443-643-1199
Mailing Address - Fax:443-643-1198
Practice Address - Street 1:500 UPPER CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4324
Practice Address - Country:US
Practice Address - Phone:443-643-1199
Practice Address - Fax:443-643-1198
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPPER CHESAPEAKE MEDICAL SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty