Organization
BROCKTON RADIATION ONCOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICKLAS B OLDENBURG MD (MEDICAL DIRECTOR)
(401) 521-9700
Entity
Organization
Contact information
Practice address
680 CENTRE ST, BROCKTON, MA 02302-3308
(401) 521-9700
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
—
110081865A
—
MA
01
—
DP1017
RR MEDICARE
MA
Enumeration date
04/10/2008
Last updated
06/21/2018
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