=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194739482
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONCOLOGY CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2006
-----------------------------------------------------
Last Update Date | 11/21/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 FRANKLIN TOWN BLVD SUITE #100
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19103-1238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-599-1100
-----------------------------------------------------
Fax | 215-599-2485
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 FRANKLIN TOWN BLVD SUITE #100
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19103-1238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-599-1100
-----------------------------------------------------
Fax | 215-599-2485
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROPRIETOR
-----------------------------------------------------
Name | DR. DONNA J GLOVER
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 215-599-1100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD021901E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------