Provider Demographics
NPI:1508851684
Name:PARKERSBURG ONCOLOGY ASSOC INC
Entity Type:Organization
Organization Name:PARKERSBURG ONCOLOGY ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIK
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-422-7555
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26102-0779
Mailing Address - Country:US
Mailing Address - Phone:304-422-7555
Mailing Address - Fax:304-485-4466
Practice Address - Street 1:705 GARFIELD AVE
Practice Address - Street 2:STE 220
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5444
Practice Address - Country:US
Practice Address - Phone:304-422-7555
Practice Address - Fax:304-485-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9918961Medicare PIN