Provider Demographics
NPI:1134120199
Name:MEDICAL ONCOLOGY ASSOCIATES OF WYOMING VALLEY, PC
Entity Type:Organization
Organization Name:MEDICAL ONCOLOGY ASSOCIATES OF WYOMING VALLEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:GREENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-288-7231
Mailing Address - Street 1:382 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5535
Mailing Address - Country:US
Mailing Address - Phone:570-288-7231
Mailing Address - Fax:
Practice Address - Street 1:382 PIERCE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5535
Practice Address - Country:US
Practice Address - Phone:570-288-7231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007619470002Medicaid
PA143126Medicare ID - Type Unspecified