Provider Demographics
NPI:1578741971
Name:STARK RADIATION ONCOLOGY INC.
Entity Type:Organization
Organization Name:STARK RADIATION ONCOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-454-2210
Mailing Address - Street 1:PO BOX 80468
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-0468
Mailing Address - Country:US
Mailing Address - Phone:330-454-2210
Mailing Address - Fax:330-454-9397
Practice Address - Street 1:300 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2073
Practice Address - Country:US
Practice Address - Phone:330-454-2210
Practice Address - Fax:330-454-9397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2152030Medicaid
OHCG3181OtherRAILROAD MEDICARE PTAN
OHCG3181OtherRAILROAD MEDICARE PTAN