Provider Demographics
NPI:1356361174
Name:SAMPSON RADIATION ONCOLOGY, PA
Entity type:Organization
Organization Name:SAMPSON RADIATION ONCOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-734-7265
Mailing Address - Street 1:215 BEAMAN STREET
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328
Mailing Address - Country:US
Mailing Address - Phone:910-590-2065
Mailing Address - Fax:910-590-2964
Practice Address - Street 1:215 BEAMAN STREET
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328
Practice Address - Country:US
Practice Address - Phone:910-590-2065
Practice Address - Fax:910-590-2964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty