Healthcare Provider Details

I. General information

NPI: 1467721191
Provider Name (Legal Business Name): HEMATOLOGY & ONCOLOGY ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 HARRISON AVE NW SUITE 104
CANTON OH
44708-2621
US

IV. Provider business mailing address

1455 HARRISON AVE NW SUITE 105
CANTON OH
44708-2621
US

V. Phone/Fax

Practice location:
  • Phone: 330-453-9993
  • Fax: 330-453-9996
Mailing address:
  • Phone: 330-453-9993
  • Fax: 330-453-9996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35054338
License Number StateOH

VIII. Authorized Official

Name: MITCHELL HAUT
Title or Position: PRESIDENT
Credential: MD
Phone: 330-453-9993