Organization
CHARLESTON RADIATION THERAPY CONSULTANTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA HORTON (PROVIDER ENROLLMENT COORDINATOR)
(800) 451-4959
Entity
Organization
Contact information
Practice address
3415 MACCORKLE AVE SE, CHARLESTON, WV 25304
(304) 388-1790
(304) 388-1768
Mailing address
PO BOX 896158, CHARLOTTE, NC 28289-6158
(800) 451-4959
(602) 773-3664
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
001
WV
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0007557000
—
WV
Enumeration date
07/12/2005
Last updated
07/21/2022
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