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General NPI Number Information
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NPI Number | 1639215114
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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 | 01/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 31 E MAIN ST SUITE 2
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City | SHELBY
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State | OH
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Zip | 44875-1262
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Country | US
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Telephone | 419-342-2775
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Fax | 419-342-2237
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Provider Business Mailing Address
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Address Line | 371 CLINE AVE
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City | MANSFIELD
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State | OH
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Zip | 44907-1021
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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 | DONALD LEE DEWALD
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Credential | M.D.
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Telephone | 419-342-2775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | OH
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