Provider Demographics
NPI:1518903269
Name:DANVILLE HEMATOLOGY & ONCOLOGY, INC.
Entity Type:Organization
Organization Name:DANVILLE HEMATOLOGY & ONCOLOGY, INC.
Other - Org Name:DANVILLE CANCER CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROTHERTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-793-0044
Mailing Address - Street 1:125 EXECUTIVE DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4155
Mailing Address - Country:US
Mailing Address - Phone:434-793-0044
Mailing Address - Fax:434-792-8864
Practice Address - Street 1:125 EXECUTIVE DR
Practice Address - Street 2:SUITE J
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4155
Practice Address - Country:US
Practice Address - Phone:434-793-0044
Practice Address - Fax:434-792-8864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0307190001Medicare NSC
VAC01980Medicare ID - Type UnspecifiedGROUP NUMBER