Provider Demographics
NPI:1114129574
Name:HEMATOLOGY ONCOLOGY ASSOC LTD
Entity Type:Organization
Organization Name:HEMATOLOGY ONCOLOGY ASSOC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:F
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:703-379-9111
Mailing Address - Street 1:5226 DAWES AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311
Mailing Address - Country:US
Mailing Address - Phone:703-379-9111
Mailing Address - Fax:703-931-7952
Practice Address - Street 1:5226 DAWES AVENUE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311
Practice Address - Country:US
Practice Address - Phone:703-379-9111
Practice Address - Fax:703-931-7952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101018898207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6024262Medicaid
DC0001OtherBS
3600054OtherUNITED HEALTH CARE
37380001OtherALLIANCE CAPITAL CARE
6024262OtherMEDICAID UNICARE
VA017081OtherBSVA
212333OtherMDSPA
VA281815OtherAMERIGROUP
DC3738OtherBS
DC0001OtherBS
212333OtherMDSPA
3600054OtherUNITED HEALTH CARE