Provider Demographics
NPI:1861656308
Name:WASHINGTON RADIATION ONCOLOGY CENTER, A MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:WASHINGTON RADIATION ONCOLOGY CENTER, A MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-795-2026
Mailing Address - Street 1:39101 CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5817
Mailing Address - Country:US
Mailing Address - Phone:510-796-7212
Mailing Address - Fax:510-745-6469
Practice Address - Street 1:39101 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-5817
Practice Address - Country:US
Practice Address - Phone:510-796-7212
Practice Address - Fax:510-745-6469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG366002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty