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	207RH0003X	Hematology & Oncology Physician		OH

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	:	1639215114
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO CANCER SPECIALISTS

Provider Business Mailing Address
First Line	:	371 CLINE AVE
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-1021
Country	:	US
Telephone Number	:	419-756-2122
Fax Number	:	419-756-3530

Provider Business Practice Location Address
First Line	:	31 E MAIN ST
Second Line	:	SUITE 2
City	:	SHELBY
State	:	OH
Zip	:	44875-1262
Country	:	US
Telephone Number	:	419-342-2775
Fax Number	:	419-342-2237

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DONALD LEE DEWALD
Credential	:	M.D.
Telephone Number	:	419-342-2775

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/22/2020

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