Healthcare Provider Details

I. General information

NPI: 1174552913
Provider Name (Legal Business Name): NORTH COAST CANCER CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 QUARRY LAKES DR.
SANDUSKY OH
44870-4132
US

IV. Provider business mailing address

417 QUARRY LAKES DR.
SANDUSKY OH
44870-4132
US

V. Phone/Fax

Practice location:
  • Phone: 419-626-9090
  • Fax:
Mailing address:
  • Phone: 419-626-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. STEVEN GALE ROSHON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 419-626-9090