1043265820 NPI number — CONSULTANTS IN MEDICAL ONCOLOGY & HEMATOLOGY, PC

Table of content: (NPI 1043265820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043265820 NPI number — CONSULTANTS IN MEDICAL ONCOLOGY & HEMATOLOGY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSULTANTS IN MEDICAL ONCOLOGY & HEMATOLOGY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043265820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 LAWRENCE RD STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOMALL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19008-3301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-492-5900
Provider Business Mailing Address Fax Number:
610-492-5903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 LAWRENCE RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BROOMALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19008-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-492-5900
Provider Business Practice Location Address Fax Number:
610-492-5903
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KEENEY
Authorized Official First Name:
LOREY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
610-492-5900

Provider Taxonomy Codes

  • Taxonomy code: 207RH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000581623 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0016055320006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0403328000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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