Provider Demographics
NPI:1720419955
Name:RADIATION THERAPY ASSOCIATES OF WESTERN NORTH CAROLINA PA
Entity Type:Organization
Organization Name:RADIATION THERAPY ASSOCIATES OF WESTERN NORTH CAROLINA PA
Other - Org Name:PULMONARY SPECIALISTS OF WESTERN NORTH CAROLINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHAFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-456-2690
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:600 HOSPITAL DR
Practice Address - Street 2:SUITE 4
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8046
Practice Address - Country:US
Practice Address - Phone:828-456-7226
Practice Address - Fax:828-456-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2019-07-19
Deactivation Date:2019-07-11
Deactivation Code:
Reactivation Date:2019-07-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty