Provider Demographics
NPI:1124381959
Name:SHENANDOAH ONCOLOGY, PC
Entity Type:Organization
Organization Name:SHENANDOAH ONCOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-662-1108
Mailing Address - Street 1:400 CAMPUS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2873
Mailing Address - Country:US
Mailing Address - Phone:540-662-1108
Mailing Address - Fax:540-667-3408
Practice Address - Street 1:400 CAMPUS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6906
Practice Address - Country:US
Practice Address - Phone:540-662-1108
Practice Address - Fax:540-662-1108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101019275207RH0003X
VA0101040514207RH0003X
VA0101041458207RH0003X
VA0101055301207RH0003X
VA0101236276207RH0003X
VA0101242990207RH0003X
207RH0003X
VA0101257872207RH0003X
VA01012584282085R0001X
VA01010458582085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV5881B652Medicare PIN
VAVV7538B652Medicare PIN
VAVV7660B652Medicare PIN
VAVV7597B652Medicare PIN
VAVVD531B652Medicare PIN
VAVVI226B652Medicare PIN
VAVV7594B652Medicare PIN
VAVVI272B652Medicare PIN
VAVV7599B652Medicare PIN