Healthcare Provider Details

I. General information

NPI: 1356302178
Provider Name (Legal Business Name): BERKS HEMATOLOGY ONCOLOGY ASSOC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S 6TH AVE & SPRUCE ST TRHMC REGIONAL CANCER CENTER N-GROUND
WEST READING PA
19611
US

IV. Provider business mailing address

PO BOX 16052
READING PA
19612-6052
US

V. Phone/Fax

Practice location:
  • Phone: 610-374-4404
  • Fax: 610-374-1396
Mailing address:
  • Phone: 610-374-4404
  • Fax: 610-374-1396

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 Number
License Number StatePA

VIII. Authorized Official

Name: MR. NICK C. LEASURE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 610-374-4404