Provider Demographics
NPI:1558087056
Name:HAWTHORNE ONCOLOGY PAIN EXPERTS LLC
Entity Type:Organization
Organization Name:HAWTHORNE ONCOLOGY PAIN EXPERTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PODGORSKI
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:215-779-9999
Mailing Address - Street 1:2727 W MLK BLVD STE 520
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6000
Mailing Address - Country:US
Mailing Address - Phone:813-538-7600
Mailing Address - Fax:813-538-7600
Practice Address - Street 1:2727 WEST MARTIN LUTHER KING BLVD, SUITE 520
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:215-779-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty