Provider Demographics
NPI:1891737508
Name:HAVERTOWN RADIOSURGERY CENTER, PC
Entity Type:Organization
Organization Name:HAVERTOWN RADIOSURGERY CENTER, PC
Other - Org Name:CYBERKNIFE CENTER OF PHILADELPHIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUTHER
Authorized Official - Middle Name:WELDON
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:610-446-6850
Mailing Address - Street 1:2010 W CHESTER PIKE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2700
Mailing Address - Country:US
Mailing Address - Phone:610-446-6850
Mailing Address - Fax:610-446-6852
Practice Address - Street 1:2010 W CHESTER PIKE
Practice Address - Street 2:SUITE 115
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2700
Practice Address - Country:US
Practice Address - Phone:610-446-6850
Practice Address - Fax:610-446-6852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAC20-48878261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103754Medicare ID - Type UnspecifiedRADIATION THERAPY CENTER