Provider Demographics
NPI:1518908847
Name:NEWPORT COAST RADIATION ONCOLOGY MEDICAL GROUP, INC
Entity type:Organization
Organization Name:NEWPORT COAST RADIATION ONCOLOGY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:615-296-0952
Mailing Address - Street 1:PO BOX 8598
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-8605
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:949-263-0473
Practice Address - Street 1:ONE HOAG DRIVE
Practice Address - Street 2:CANCER CENTER
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-764-5528
Practice Address - Fax:949-764-8106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG536772085R0001X
CAG280372085R0203X
CAA707562085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0087510Medicaid
CAZZZ60882ZOtherBLUE SHIELD OF CA
CAGR0087510Medicaid
CAHW14792Medicare PIN