1457328668 NPI number — EAST SHORE ONCOLOGY PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457328668 NPI number — EAST SHORE ONCOLOGY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST SHORE ONCOLOGY 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:
1457328668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 E PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17111-2758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-558-7350
Provider Business Mailing Address Fax Number:
717-558-7353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 E PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17111-2758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-558-7350
Provider Business Practice Location Address Fax Number:
717-558-7353
Provider Enumeration Date:
03/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
RONDA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
717-558-7350

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  MD031315E , 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: 02440100 . This is a "KEYSTONE CENTRAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02440100 . This is a "SENIOR BLUE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0010993580002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 472428 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7195254 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02440100 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 73750 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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