=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003024720
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PENNSYLVANIA ONCOLOGY HEMATOLOGY ASSOCIATES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2007
-----------------------------------------------------
Last Update Date | 05/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 KING OF PRUSSIA RD STE 1B
-----------------------------------------------------
City | RADNOR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19087-5220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-902-5950
-----------------------------------------------------
Fax | 610-902-5959
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 230 W WASHINGTON SQ 2ND FLOOR
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19106-3500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SEC AND TREASURER
-----------------------------------------------------
Name | DAVID HENRY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-829-6088
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number | MD021663E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------