Provider Demographics
NPI:1508104043
Name:MAIN LINE ONCOLOGY HEMATOLOGY ASSOC
Entity Type:Organization
Organization Name:MAIN LINE ONCOLOGY HEMATOLOGY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-645-2494
Mailing Address - Street 1:100 E LANCASTER AVE STE B20
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-645-2494
Mailing Address - Fax:610-645-4456
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:CANCER CENTER
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-645-2494
Practice Address - Fax:610-645-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012692363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty