1003024720 NPI number — PENNSYLVANIA ONCOLOGY HEMATOLOGY ASSOCIATES, PC

Table of content: (NPI 1003024720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003024720 NPI number — PENNSYLVANIA ONCOLOGY HEMATOLOGY ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENNSYLVANIA ONCOLOGY HEMATOLOGY ASSOCIATES, 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:
6
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:
1003024720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 W WASHINGTON SQ
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19106-3500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 KING OF PRUSSIA RD
Provider Second Line Business Practice Location Address:
STE 1B
Provider Business Practice Location Address City Name:
RADNOR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19087-5220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-902-5950
Provider Business Practice Location Address Fax Number:
610-902-5959
Provider Enumeration Date:
05/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
SEC AND TREASURER
Authorized Official Telephone Number:
215-829-6088

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  MD021663E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0009549220002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0017646000004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3987483 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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