Provider Demographics
NPI:1134517352
Name:ONCOMED SPECIALTY LLC
Entity Type:Organization
Organization Name:ONCOMED SPECIALTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:CANERIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-627-7100
Mailing Address - Street 1:1901 CAMPUS PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2308
Mailing Address - Country:US
Mailing Address - Phone:502-627-7100
Mailing Address - Fax:855-217-7498
Practice Address - Street 1:225 COMMUNITY DR
Practice Address - Street 2:STE 100
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5503
Practice Address - Country:US
Practice Address - Phone:516-869-0920
Practice Address - Fax:516-439-4266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy