Healthcare Provider Details

I. General information

NPI: 1457360471
Provider Name (Legal Business Name): LEBANON ONCOLOGY & HEMATOLOGY ASSOC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4TH & WILLOW ST HYMAN S CAPLAN PAVILION
LEBANON PA
17046
US

IV. Provider business mailing address

220 S RAILROAD ST P.O. BOX 312
PALMYRA PA
17078
US

V. Phone/Fax

Practice location:
  • Phone: 717-274-8875
  • Fax:
Mailing address:
  • Phone: 717-838-6462
  • Fax: 717-838-5659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036017E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberPE133702
License Number StatePA

VIII. Authorized Official

Name: DR. RUBEN PEREZ
Title or Position: PHYSICIAN
Credential: MD
Phone: 717-274-8873