Provider Demographics
NPI:1457328668
Name:EAST SHORE ONCOLOGY PC
Entity Type:Organization
Organization Name:EAST SHORE ONCOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-558-7350
Mailing Address - Street 1:750 E PARK DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2758
Mailing Address - Country:US
Mailing Address - Phone:717-558-7350
Mailing Address - Fax:717-558-7353
Practice Address - Street 1:750 E PARK DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-2758
Practice Address - Country:US
Practice Address - Phone:717-558-7350
Practice Address - Fax:717-558-7353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031315E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02440100OtherKEYSTONE CENTRAL
PA02440100OtherSENIOR BLUE
PA0010993580002Medicaid
PA472428OtherAETNA
PA7195254OtherGATEWAY
PA02440100OtherCAPITAL BLUE CROSS
PA73750OtherHEALTH AMERICA
PA031961Medicare PIN