Provider Demographics
NPI:1588729727
Name:RADIATION ONCOLOGY MEDICAL PARTNERS INC
Entity type:Organization
Organization Name:RADIATION ONCOLOGY MEDICAL PARTNERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOWIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-947-2995
Mailing Address - Street 1:PO BOX 5040
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128
Mailing Address - Country:US
Mailing Address - Phone:408-947-2995
Mailing Address - Fax:408-947-2687
Practice Address - Street 1:2105 FOREST AVENUE
Practice Address - Street 2:O CONNOR HOSPITAL
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128
Practice Address - Country:US
Practice Address - Phone:408-947-2995
Practice Address - Fax:408-947-2687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0087800Medicaid
CAGR0087800Medicaid
CAGR0087800Medicaid