MEDICARE: SEWICKLEY MEDICAL ONCOLOGY HEMATOLOGY GROUP-UPCI

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	291U00000X	Clinical Medical Laboratory	39D1027607	PA
2	207RH0003X	Hematology & Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	951583	OTHER	PA	HIGHMARK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0018806270008	OTHER	PA	CLIA LAB
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841267275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEWICKLEY MEDICAL ONCOLOGY HEMATOLOGY GROUP-UPCI

Provider Business Mailing Address
First Line	:	2 HOT METAL ST
Second Line	:	QUANTUM ONE, N430
City	:	PITTSBURGH
State	:	PA
Zip	:	15203-2348
Country	:	US
Telephone Number	:	412-432-7706
Fax Number	:	412-432-7691

Provider Business Practice Location Address
First Line	:	1600 CORAOPOLIS HEIGHTS RD
Second Line	:	SUITE F
City	:	MOON TOWNSHIP
State	:	PA
Zip	:	15108-4316
Country	:	US
Telephone Number	:	412-329-2500
Fax Number	:	412-329-2540

Authorized Official
Title or Position	:	VICE PRESIDENT - CANCER SERVICES
Name	:	CHARLES E BOGOSTA
Credential	:
Telephone Number	:	412-692-2451

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	05/08/2009

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