Healthcare Provider Details

I. General information

NPI: 1861590234
Provider Name (Legal Business Name): HEMATOLOGY ONCOLOGY ASSOCIATES OF BATON ROUGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 ESSEN LN
BATON ROUGE LA
70809-3432
US

IV. Provider business mailing address

4950 ESSEN LN
BATON ROUGE LA
70809-3482
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-1311
  • Fax: 225-215-1658
Mailing address:
  • Phone: 225-767-1311
  • Fax: 225-767-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: MR. PAUL NOWACKI
Title or Position: BUSINESS MANAGER
Credential:
Phone: 225-215-1131