Provider Demographics
NPI:1699747683
Name:VENANGO ONCOLOGY HEMATOLOGY ASSOCIATION, P.C.
Entity type:Organization
Organization Name:VENANGO ONCOLOGY HEMATOLOGY ASSOCIATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRTLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-437-7891
Mailing Address - Street 1:1339 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-1528
Mailing Address - Country:US
Mailing Address - Phone:814-437-7891
Mailing Address - Fax:814-432-7714
Practice Address - Street 1:1339 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-1528
Practice Address - Country:US
Practice Address - Phone:814-437-7891
Practice Address - Fax:814-432-7714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CJ8400OtherRAILROAD
5185570001Medicare NSC
056174QEPMedicare PIN