Healthcare Provider Details

I. General information

NPI: 1396742557
Provider Name (Legal Business Name): MEDICAL ONCOLOGY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2005
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 LAKE AVE
ASHTABULA OH
44004-4977
US

IV. Provider business mailing address

29349 GATES MILLS BLVD
PEPPER PIKE OH
44124-4651
US

V. Phone/Fax

Practice location:
  • Phone: 440-997-7785
  • Fax: 440-998-0652
Mailing address:
  • Phone: 216-831-6493
  • Fax: 216-831-6413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number35 . 053339
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number35 . 053339
License Number StateOH

VIII. Authorized Official

Name: DR. MOHAMMAD ALI VARGHAI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 440-997-7785