Provider Demographics
NPI:1225045636
Name:MEDICAL ONCOLOGY AND BLOOD DISORDERS, LLP
Entity Type:Organization
Organization Name:MEDICAL ONCOLOGY AND BLOOD DISORDERS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BYREM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:860-533-3091
Mailing Address - Street 1:100 HAYNES ST FL 2
Mailing Address - Street 2:BUSINESS OFFICE
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4113
Mailing Address - Country:US
Mailing Address - Phone:860-533-3091
Mailing Address - Fax:860-533-3096
Practice Address - Street 1:100 HAYNES ST FL 2
Practice Address - Street 2:DEQUATTRO COMMUNITY CANCER CENTER
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4113
Practice Address - Country:US
Practice Address - Phone:860-646-0670
Practice Address - Fax:860-643-9388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004395085Medicaid
CTC00532Medicare PIN