=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912959016
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEMATOLOGY ONCOLOGY CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 02/25/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41201 SCHADDEN RD SUITE 2
-----------------------------------------------------
City | ELYRIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44035-2220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-324-0401
-----------------------------------------------------
Fax | 440-324-0405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41201 SCHADDEN RD SUITE 2
-----------------------------------------------------
City | ELYRIA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44035-2220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-324-0401
-----------------------------------------------------
Fax | 440-324-0405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BELAGODU N KANTHARAJ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 440-324-0401
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0003X
-----------------------------------------------------
Taxonomy Name | Hematology & Oncology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------