Provider Demographics
NPI:1053345181
Name:ADVANCED RADIATION ONCOLOGY P.A.
Entity type:Organization
Organization Name:ADVANCED RADIATION ONCOLOGY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:HEROLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-744-4400
Mailing Address - Street 1:PO BOX 2760
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-2760
Mailing Address - Country:US
Mailing Address - Phone:561-744-4400
Mailing Address - Fax:561-744-7408
Practice Address - Street 1:1240 S OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7205
Practice Address - Country:US
Practice Address - Phone:561-744-4400
Practice Address - Fax:561-744-7408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271569400Medicaid
FL74711OtherBCBS
FL271569400Medicaid