Healthcare Provider Details

I. General information

NPI: 1083714463
Provider Name (Legal Business Name): KEYSTONE ONCOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2494 BERNVILLE RD SUITE G03
READING PA
19605-9469
US

IV. Provider business mailing address

P O BOX 7282
LANCASTER PA
17603
US

V. Phone/Fax

Practice location:
  • Phone: 601-378-2061
  • Fax:
Mailing address:
  • Phone: 601-378-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberOS007188L
License Number StatePA

VIII. Authorized Official

Name: DR. PATRICK COLARUSSO
Title or Position: OWNER
Credential: D.O.
Phone: 610-378-2061