Provider Demographics
NPI:1972956605
Name:SHENANDOAH ONCOLOGY, PC
Entity type:Organization
Organization Name:SHENANDOAH ONCOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:CORRINE
Authorized Official - Last Name:GROESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-662-1108
Mailing Address - Street 1:1870 AMHERST ST STE F
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2841
Mailing Address - Country:US
Mailing Address - Phone:540-662-1108
Mailing Address - Fax:540-450-2244
Practice Address - Street 1:400 CAMPUS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6906
Practice Address - Country:US
Practice Address - Phone:540-662-1108
Practice Address - Fax:540-450-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041458174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV7597B652Medicare UPIN