Healthcare Provider Details

I. General information

NPI: 1083800908
Provider Name (Legal Business Name): HOPE CANCER CENTER OF NORTHWEST OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N EASTOWN RD
LIMA OH
45807-2268
US

IV. Provider business mailing address

825 W MARKET ST 260
LIMA OH
45805-2799
US

V. Phone/Fax

Practice location:
  • Phone: 419-998-8288
  • Fax: 419-998-8289
Mailing address:
  • Phone: 419-222-6595
  • Fax: 419-222-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier9334231
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: DR. RAVI MADAN
Title or Position: CEO/PRESIDENT
Credential: M.D.
Phone: 419-222-6595