Provider Demographics
NPI:1194739482
Name:ONCOLOGY CARE LLC
Entity type:Organization
Organization Name:ONCOLOGY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-599-1100
Mailing Address - Street 1:2 FRANKLIN TOWN BLVD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1238
Mailing Address - Country:US
Mailing Address - Phone:215-599-1100
Mailing Address - Fax:215-599-2485
Practice Address - Street 1:2 FRANKLIN TOWN BLVD
Practice Address - Street 2:SUITE #100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1238
Practice Address - Country:US
Practice Address - Phone:215-599-1100
Practice Address - Fax:215-599-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021901E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA793518Medicaid
PA036767Medicare PIN