Provider Demographics
NPI:1275827891
Name:MARYLAND ONCOLOGY HEMATOLOGY, P.A.
Entity Type:Organization
Organization Name:MARYLAND ONCOLOGY HEMATOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:MINFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-964-2212
Mailing Address - Street 1:10710 CHARTER DR
Mailing Address - Street 2:SUITE G020
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3128
Mailing Address - Country:US
Mailing Address - Phone:410-964-2212
Mailing Address - Fax:410-964-1111
Practice Address - Street 1:40 V TWIN DR
Practice Address - Street 2:SUITE 104
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7875
Practice Address - Country:US
Practice Address - Phone:717-338-9009
Practice Address - Fax:717-334-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD30573207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026042650001Medicaid
PA1026042650001Medicaid