Healthcare Provider Details

I. General information

NPI: 1841267275
Provider Name (Legal Business Name): SEWICKLEY MEDICAL ONCOLOGY HEMATOLOGY GROUP-UPCI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 05/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CORAOPOLIS HEIGHTS RD SUITE F
MOON TOWNSHIP PA
15108-4316
US

IV. Provider business mailing address

2 HOT METAL ST QUANTUM ONE, N430
PITTSBURGH PA
15203-2348
US

V. Phone/Fax

Practice location:
  • Phone: 412-329-2500
  • Fax: 412-329-2540
Mailing address:
  • Phone: 412-432-7706
  • Fax: 412-432-7691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number39D1027607
License Number StatePA

VIII. Authorized Official

Name: CHARLES E BOGOSTA
Title or Position: VICE PRESIDENT - CANCER SERVICES
Credential:
Phone: 412-692-2451