Provider Demographics
NPI:1417033796
Name:MD ONCOLOGY, PLLC
Entity Type:Organization
Organization Name:MD ONCOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMBROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-486-0600
Mailing Address - Street 1:125 RED CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-4272
Mailing Address - Country:US
Mailing Address - Phone:585-486-0600
Mailing Address - Fax:585-486-0649
Practice Address - Street 1:125 RED CREEK DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4272
Practice Address - Country:US
Practice Address - Phone:585-486-0600
Practice Address - Fax:585-486-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0932Medicare PIN