Provider Demographics
NPI:1639344906
Name:INTEGRATED RADIATION ONCOLOGY LLC AT SHADY GROVE
Entity Type:Organization
Organization Name:INTEGRATED RADIATION ONCOLOGY LLC AT SHADY GROVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:COLEMAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-762-5595
Mailing Address - Street 1:9711 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3323
Mailing Address - Country:US
Mailing Address - Phone:301-762-5595
Mailing Address - Fax:301-762-1165
Practice Address - Street 1:9711 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 111
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3323
Practice Address - Country:US
Practice Address - Phone:301-762-5595
Practice Address - Fax:301-762-1165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty