MEDICARE: DELTA ONCOLOGY ASSOCIATES PC

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	2085R0202X	Diagnostic Radiology Physician	0101031778	VA
2	2086X0206X	Surgical Oncology Physician	0101230703	VA
3	208600000X	Surgery Physician	0101230703	VA
4	207RH0003X	Hematology & Oncology Physician	0101058359	VA
5	207RX0202X	Medical Oncology Physician	0101058359	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48802	OTHER		AETNA
2	0184F	OTHER	NC	BCBS NC
3	091524	OTHER		ANTHEM BCBS

General Provider Information

NPI Number	:	1184666943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELTA ONCOLOGY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	355 CRAWFORD ST
Second Line	:	SUITE 300
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-2816
Country	:	US
Telephone Number	:	757-396-6333
Fax Number	:	757-215-0177

Provider Business Practice Location Address
First Line	:	355 CRAWFORD ST
Second Line	:	SUITE 300
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-2816
Country	:	US
Telephone Number	:	757-396-6333
Fax Number	:	757-215-0177

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LLOYD A SHABAZZ
Credential	:	M.D.
Telephone Number	:	757-396-6333

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	05/10/2010

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