MEDICARE: GYNECOLOGIC ONCOLOGY ASSOCITAES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0201X	Gynecologic Oncology Physician

General Provider Information

NPI Number	:	1083863625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GYNECOLOGIC ONCOLOGY ASSOCITAES, INC

Provider Business Mailing Address
First Line	:	PO BOX 816967
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33081-0967
Country	:	US
Telephone Number	:	954-838-2371
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 WASHINGTON ST
Second Line	:	SUITE#104
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-8256
Country	:	US
Telephone Number	:	954-847-7373
Fax Number	:	954-874-7374

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT COWARD
Credential	:
Telephone Number	:	954-838-2371

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	03/16/2011

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