Fox Chase Cancer Center Medical Group, Inc

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

FOX CHASE CANCER CENTER MEDICAL GROUP, INC

Doing business as

Rad Assoc of FCCC, MGI

Practice address

333 Cottman Ave
Fox Chase Cancer Center
Philadelphia, PA 19111-2434

Phone

(215) 728-3883

Fax

(215) 728-1185

NPI assigned

Mar 7, 2012

Last updated

Jun 14, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tonya Woodard

Title

Credentialing/Manager

Phone

(215) 707-3911

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Rad Assoc of FCCC, MGI Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528934400000",
    "number": "1437423514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-728-3883",
            "fax_number": "215-728-1185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 COTTMAN AVE",
            "address_2": "FOX CHASE CANCER CENTER",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191112434",
            "telephone_number": "215-728-3883",
            "fax_number": "215-728-1185"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2365 Heritage Center Dr",
            "address_purpose": "LOCATION",
            "city": "Furlong",
            "state": "PA",
            "postal_code": "189251280",
            "country_code": "US",
            "telephone_number": "215-728-3883",
            "fax_number": "215-728-1185",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOX CHASE CANCER CENTER MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-07",
        "last_updated": "2018-06-14",
        "status": "A",
        "authorized_official_last_name": "WOODARD",
        "authorized_official_first_name": "TONYA",
        "authorized_official_title_or_position": "CREDENTIALING/MANAGER",
        "authorized_official_telephone_number": "215-707-3911"
    },
    "taxonomies": [
        {
            "code": "2085N0904X",
            "taxonomy_group": "",
            "desc": "Radiology, Nuclear Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1026888280004",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1026888280032",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rad Assoc of FCCC, MGI",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rad Assoc of FCCC, MGI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Fox Chase Cancer Center Medical Group, Inc (Thor Surg Assoc of FCCC, MGI)
• Fox Chase Cancer Center Medical Group, Inc (Plastic/Recon Assoc of FCCC, MGI)
• Fox Chase Cancer Center Medical Group, Inc (Psychology Assoc of FCCC, MGI)
• Fox Chase Cancer Center Medical Group, Inc (PATH Assoc of FCCC, MGI)
• Fox Chase Cancer Center Medical Group, Inc (Uro Assoc of FCCC, MGI)
• Fox Chase Cancer Center Medical Group, Inc (Med Onc Assoc of FCCC, MGI)
• Fox Chase Cancer Center Medical Group, Inc (Otolaryn Assoc of FCCC, MGI)
• Fox Chase Cancer Center Medical Group, Inc (Pain Mana Assoc of FCCC, MGI)
• Fox Chase Cancer Center Medical Group, Inc (Gen Surg Assoc of FCCC, MGI)
• Fox Chase Cancer Center Medical Group, Inc (RadOnc Assoc of FCCC, MGI)

• Diagnostic Radiology Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Diagnostic Radiology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.