MEDICARE: PEDIATRIC HEMATOLOGY ONCOLOGY ASSOCIATES, P.C.

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	174400000X	Specialist	9868	AZ

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

General Provider Information

NPI Number	:	1467594598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC HEMATOLOGY ONCOLOGY ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	333 E VIRGINIA AVE
Second Line	:	#210
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1206
Country	:	US
Telephone Number	:	602-253-5993
Fax Number	:	602-253-4254

Provider Business Practice Location Address
First Line	:	333 E VIRGINIA AVE
Second Line	:	#210
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1206
Country	:	US
Telephone Number	:	602-253-5993
Fax Number	:	602-253-4254

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JESSE D COHEN
Credential	:	M.D.
Telephone Number	:	602-253-5993

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	08/22/2020

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