Provider Demographics
NPI:1992721153
Name:LYNCHBURG HEMATOLOGY ONCOLOGY CLINIC INC.
Entity type:Organization
Organization Name:LYNCHBURG HEMATOLOGY ONCOLOGY CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:OLDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-200-5925
Mailing Address - Street 1:1701 THOMSON DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1101
Mailing Address - Country:US
Mailing Address - Phone:434-200-5925
Mailing Address - Fax:434-200-5929
Practice Address - Street 1:1701 THOMSON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1101
Practice Address - Country:US
Practice Address - Phone:434-200-5925
Practice Address - Fax:434-200-5929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0272400001Medicare NSC
VAB08694Medicare UPIN