Provider Demographics
NPI:1982615399
Name:ALLIANCE CANCER SPECIALIST
Entity type:Organization
Organization Name:ALLIANCE CANCER SPECIALIST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINGATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-658-7252
Mailing Address - Street 1:201 GIBRALTAR RD
Mailing Address - Street 2:STE 120
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2331
Mailing Address - Country:US
Mailing Address - Phone:215-658-7252
Mailing Address - Fax:215-706-4477
Practice Address - Street 1:201 GIBRALTAR RD
Practice Address - Street 2:STE 120
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-2331
Practice Address - Country:US
Practice Address - Phone:215-658-7252
Practice Address - Fax:215-706-4477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONSULTANTS IN MEDICAL ONCOLOGY & HEMATOLOGY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-10
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025419E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA028498Medicare ID - Type Unspecified
PA6725440001Medicare NSC