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	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1578502423
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 102
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-2816
Country	:	US
Telephone Number	:	757-397-3400
Fax Number	:	757-399-0371

Provider Business Practice Location Address
First Line	:	355 CRAWFORD ST
Second Line	:	SUITE 102
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-2816
Country	:	US
Telephone Number	:	757-397-3400
Fax Number	:	757-399-0371

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	01/07/2008

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Practice Fax: 757-215-0177

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