Provider Demographics
NPI:1083714463
Name:KEYSTONE ONCOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:KEYSTONE ONCOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:COLARUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-378-2061
Mailing Address - Street 1:P O BOX 7282
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603
Mailing Address - Country:US
Mailing Address - Phone:601-378-2061
Mailing Address - Fax:
Practice Address - Street 1:2494 BERNVILLE RD
Practice Address - Street 2:SUITE G03
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-9469
Practice Address - Country:US
Practice Address - Phone:601-378-2061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007188L207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016012930003Medicaid
PA076296Medicare PIN
PA0016012930003Medicaid
PAG32778Medicare UPIN