Provider Demographics
NPI:1053461897
Name:BLOOD & CANCER CENTER, LLC
Entity Type:Organization
Organization Name:BLOOD & CANCER CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-632-1559
Mailing Address - Street 1:671 WILSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-7902
Mailing Address - Country:US
Mailing Address - Phone:717-632-1559
Mailing Address - Fax:717-632-5557
Practice Address - Street 1:671 WILSON AVE
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-7902
Practice Address - Country:US
Practice Address - Phone:717-632-1559
Practice Address - Fax:717-632-5557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418310207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018946870001Medicaid
PAG67805Medicare UPIN
PA0018946870001Medicaid