Provider Demographics
NPI:1154378867
Name:PENNSYLVANIA ONCOLOGY HEMATOLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:PENNSYLVANIA ONCOLOGY HEMATOLOGY ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-829-6088
Mailing Address - Street 1:230 W WASHINGTON SQ
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3500
Mailing Address - Country:US
Mailing Address - Phone:215-829-6088
Mailing Address - Fax:215-829-6104
Practice Address - Street 1:230 W WASHINGTON SQ
Practice Address - Street 2:2ND FL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3500
Practice Address - Country:US
Practice Address - Phone:215-829-6088
Practice Address - Fax:215-829-6104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018597E332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006622760001Medicaid
3987471OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PA001764600004Medicaid
PA001764600004Medicaid