=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053397745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEMATOLOGY ONCOLOGY PATIENT ENTERPRISES P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2005
-----------------------------------------------------
Last Update Date | 12/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 459 LOCUST AVE
-----------------------------------------------------
City | CHARLOTTESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22902-4808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-982-8410
-----------------------------------------------------
Fax | 434-982-8420
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 459 LOCUST AVE
-----------------------------------------------------
City | CHARLOTTESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22902-4808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-982-8410
-----------------------------------------------------
Fax | 434-982-8420
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEFAN GORSCH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 434-982-8410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------