Provider Demographics
NPI:1194852798
Name:ONCOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:ONCOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:B
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-356-5734
Mailing Address - Street 1:PO BOX 44047
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48244-0047
Mailing Address - Country:US
Mailing Address - Phone:248-543-8007
Mailing Address - Fax:248-543-9005
Practice Address - Street 1:22255 GREENFIELD RD
Practice Address - Street 2:STE 450
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3710
Practice Address - Country:US
Practice Address - Phone:248-356-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICV025814207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0F36464Medicare ID - Type Unspecified