Provider Demographics
NPI:1720064991
Name:EPHRATA REGIONAL RADIATION ONCOLOGY PC
Entity Type:Organization
Organization Name:EPHRATA REGIONAL RADIATION ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAMBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-738-4070
Mailing Address - Street 1:1020A E BOAL AVE
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1509
Mailing Address - Country:US
Mailing Address - Phone:814-237-8627
Mailing Address - Fax:814-238-0083
Practice Address - Street 1:460 N READING RD
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-9606
Practice Address - Country:US
Practice Address - Phone:717-738-4070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2569568OtherAETNA USHC
PA3239600OtherCAPITAL BC
PA0018480020001Medicaid
PA1519444OtherGATEWAY
PA927742OtherBCBS OF PA
PA927742OtherBCBS OF PA
PA1519444OtherGATEWAY