Provider Demographics
NPI:1912977984
Name:RADIATION ONCOLOGY AFFILIATES OF MARYLAND
Entity Type:Organization
Organization Name:RADIATION ONCOLOGY AFFILIATES OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-682-6800
Mailing Address - Street 1:9105 FRANKLIN SQUARE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3930
Mailing Address - Country:US
Mailing Address - Phone:410-682-6800
Mailing Address - Fax:410-682-2783
Practice Address - Street 1:9105 FRANKLIN SQUARE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3930
Practice Address - Country:US
Practice Address - Phone:410-682-6800
Practice Address - Fax:410-682-2783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK328Medicare PIN
MDS858Medicare PIN