Organization
RADIATION MEDICINE AFFILIATES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HAROLD JAMES WALLACE III M.D. (PRESIDENT)
(802) 847-3506
Entity
Organization
Contact information
Practice address
111 COLCHESTER AVE, FLETCHER ALLEN HEALTH CARE, DIV. OF RADIATION ONCOLOGY, BURLINGTON, VT 05401-1473
(802) 847-3506
(802) 847-2386
Mailing address
291 MOODY ST, PER SE TECHNOLOGIES, LUDLOW, MA 01056-1246
(800) 866-6663
(888) 413-1065
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0002537
—
VT
01
—
05794
CIGNA
VT
01
—
330-2537
BLUE CROSS
VT
Enumeration date
07/22/2006
Last updated
12/03/2007
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