Organization
EASTGATE RADIATION ONCOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK SHALVARJIAN (SENIOR VICE-PRESIDENT)
(310) 335-4056
Entity
Organization
Contact information
Practice address
4415 AICHOLTZ RD, CINCINNATI, OH 45245-1506
(513) 752-8100
Mailing address
PO BOX 10050, MANHATTAN BEACH, CA 90267-7550
(310) 335-4056
(310) 335-4098
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2675038
—
OH
01
—
DF8293
RAILROAD MEDICARE
OH
Enumeration date
08/29/2006
Last updated
07/09/2008
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