Provider Demographics
NPI:1780766758
Name:HUNTINGTON RADIATION MEDICAL GROUP
Entity type:Organization
Organization Name:HUNTINGTON RADIATION MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIATION ONCOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:CHANDLER
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-397-5149
Mailing Address - Street 1:100 WEST CALIFORNIA BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109
Mailing Address - Country:US
Mailing Address - Phone:626-397-5149
Mailing Address - Fax:626-397-2147
Practice Address - Street 1:100 WEST CALIFORNIA BOULEVARD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91109
Practice Address - Country:US
Practice Address - Phone:626-397-5149
Practice Address - Fax:626-397-2147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70785174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG24435Medicare UPIN