Provider Demographics
NPI:1346375029
Name:FLORIDA HEMATOLOGY & ONCOLOGY CENTER P.A.
Entity Type:Organization
Organization Name:FLORIDA HEMATOLOGY & ONCOLOGY CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ARCHAK
Authorized Official - Last Name:DERMARKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-684-2339
Mailing Address - Street 1:PO BOX 987
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-0987
Mailing Address - Country:US
Mailing Address - Phone:813-684-2339
Mailing Address - Fax:
Practice Address - Street 1:401 VONDERBURG DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5963
Practice Address - Country:US
Practice Address - Phone:813-684-2339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3130788OtherAETNA IDENTIFIER
FL17796Medicare ID - Type UnspecifiedMEDICARE ID
FLDB2805Medicare ID - Type UnspecifiedRAILROAD MEDICARE
FL3130788OtherAETNA IDENTIFIER
FLE45195Medicare UPIN