Provider Demographics
NPI:1700865342
Name:MID-HUDSON VALLEY RADIATION ONCOLOGY LLP
Entity Type:Organization
Organization Name:MID-HUDSON VALLEY RADIATION ONCOLOGY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIMITRIOS
Authorized Official - Middle Name:P
Authorized Official - Last Name:PAPADOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-431-5645
Mailing Address - Street 1:171 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1635
Mailing Address - Country:US
Mailing Address - Phone:814-237-8627
Mailing Address - Fax:814-238-0083
Practice Address - Street 1:45 READE PLACE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3947
Practice Address - Country:US
Practice Address - Phone:845-431-5645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0X00N60037OtherPHS HEALTHNET
NY70177OtherMVP
NYCB1741OtherRR MEDICARE
NY01355540Medicaid
NY0532398OtherAETNA USHC HMO
NY7065OtherCDPHP
NYCB1741OtherRR MEDICARE
NY01355540Medicaid
NYW07421Medicare PIN