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General NPI Number Information
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NPI Number | 1316917040
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Entity Type | Organization
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Legal Business Name | OHIO CANCER SPECIALISTS
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 1125 ASPIRA CT
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City | MANSFIELD
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State | OH
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Zip | 44906-4125
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Country | US
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Telephone | 419-756-2122
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Fax | 419-756-3530
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Provider Business Mailing Address
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Address Line | 1125 ASPIRA CT
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City | MANSFIELD
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State | OH
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Zip | 44906-4125
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Country | US
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Telephone | 419-756-2122
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Fax | 419-756-3530
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONALD LEE DEWALD
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Credential | M.D.
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Telephone | 419-756-2122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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