Provider Demographics
NPI:1316917040
Name:OHIO CANCER SPECIALISTS
Entity type:Organization
Organization Name:OHIO CANCER SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DEWALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-756-2122
Mailing Address - Street 1:1125 ASPIRA CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-4125
Mailing Address - Country:US
Mailing Address - Phone:419-756-2122
Mailing Address - Fax:419-756-3530
Practice Address - Street 1:1125 ASPIRA CT
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-4125
Practice Address - Country:US
Practice Address - Phone:419-756-2122
Practice Address - Fax:419-756-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2437625Medicaid
OH2411170Medicaid
OH2145691Medicaid
OH2411170Medicaid
OH4393220001Medicare NSC
OH2145691Medicaid
OH2437625Medicaid
OH9304751Medicare PIN