Healthcare Provider Details

I. General information

NPI: 1720176522
Provider Name (Legal Business Name): HEMATOLOGY ONCOLOGY PHYSICIANS EAST KENTUCKY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2737 NORTH LAUREL ROAD
LONDON KY
40741
US

IV. Provider business mailing address

73 THOMPSON POYNTER ROAD SUITE B
LONDON KY
40741
US

V. Phone/Fax

Practice location:
  • Phone: 606-843-2783
  • Fax: 606-862-4899
Mailing address:
  • Phone: 606-344-2444
  • Fax: 606-862-4899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number38197
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number40196
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number40196
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number38197
License Number StateKY

VIII. Authorized Official

Name: DR. VISAHARAN SIVASUBRAMANIAM
Title or Position: OWNER
Credential: M.D.
Phone: 606-344-2444