Provider Demographics
NPI:1902054265
Name:NORTHSTAR RADIATION ONCOLOGY LLC
Entity Type:Organization
Organization Name:NORTHSTAR RADIATION ONCOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ESSAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHIHADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-458-5380
Mailing Address - Street 1:1640 COWLES ST STE 2
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5925
Mailing Address - Country:US
Mailing Address - Phone:907-458-5380
Mailing Address - Fax:907-458-5379
Practice Address - Street 1:1640 COWLES ST STE 2
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5925
Practice Address - Country:US
Practice Address - Phone:907-458-5380
Practice Address - Fax:907-458-5379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4498174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty