Provider Demographics
NPI:1396898672
Name:PENINSULA RADIATION ONCOLOGY SPECIALISTS
Entity type:Organization
Organization Name:PENINSULA RADIATION ONCOLOGY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:T
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-625-4630
Mailing Address - Street 1:PO BOX HH
Mailing Address - Street 2:CHOMP RADIATION ONCOLOGY
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93942-6032
Mailing Address - Country:US
Mailing Address - Phone:831-625-4630
Mailing Address - Fax:831-625-4635
Practice Address - Street 1:2365 HOLMAN HIGHWAY
Practice Address - Street 2:CHOMP RADIATION ONCOLOGY
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93942
Practice Address - Country:US
Practice Address - Phone:831-625-4630
Practice Address - Fax:831-625-4635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0696302085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G657810Medicare PIN
CA90626Medicare UPIN
CAG02667Medicare UPIN
CAA23202Medicare UPIN
020A57700Medicare PIN
00G696300Medicare PIN
CAF 61686Medicare UPIN
CAZZZ21489ZMedicare ID - Type UnspecifiedMEDICARE GROUP #