Healthcare Provider Details

I. General information

NPI: 1982615399
Provider Name (Legal Business Name): ALLIANCE CANCER SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 GIBRALTAR RD STE 120
HORSHAM PA
19044-2331
US

IV. Provider business mailing address

201 GIBRALTAR RD STE 120
HORSHAM PA
19044-2331
US

V. Phone/Fax

Practice location:
  • Phone: 215-658-7252
  • Fax: 215-706-4477
Mailing address:
  • Phone: 215-658-7252
  • Fax: 215-706-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD025419E
License Number StatePA

VIII. Authorized Official

Name: MARYANN WINGATE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 215-658-7252