MEDICARE: OHIO CANCER SPECIALISTS

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	2085R0001X	Radiation Oncology Physician
2	207RH0003X	Hematology & Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316917040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO CANCER SPECIALISTS

Provider Business Mailing Address
First Line	:	1125 ASPIRA CT
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-4125
Country	:	US
Telephone Number	:	419-756-2122
Fax Number	:	419-756-3530

Provider Business Practice Location Address
First Line	:	1125 ASPIRA CT
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-4125
Country	:	US
Telephone Number	:	419-756-2122
Fax Number	:	419-756-3530

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DONALD LEE DEWALD
Credential	:	M.D.
Telephone Number	:	419-756-2122

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	09/18/2012

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Directions to “OHIO CANCER SPECIALISTS ” Practice Location

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