Healthcare Provider Details

I. General information

NPI: 1720046535
Provider Name (Legal Business Name): THE REGIONAL CANCER CENTER NEO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 LAKE AVE
ASHTABULA OH
44004-4977
US

IV. Provider business mailing address

2500 W 12TH ST
ERIE PA
16505-4508
US

V. Phone/Fax

Practice location:
  • Phone: 440-997-4554
  • Fax:
Mailing address:
  • Phone: 814-838-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: KANDY A SUSI
Title or Position: CFO
Credential:
Phone: 814-838-9000