Provider Demographics
NPI:1558581173
Name:ONCOLOGY AND HEMATOLOGY CONSULTANTS OF PALM BEACHES
Entity Type:Organization
Organization Name:ONCOLOGY AND HEMATOLOGY CONSULTANTS OF PALM BEACHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMITHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VATTIGUNTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-691-4301
Mailing Address - Street 1:12496 EQUINE LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3508
Mailing Address - Country:US
Mailing Address - Phone:561-691-4301
Mailing Address - Fax:561-691-4517
Practice Address - Street 1:3385 BURNS RD STE 203
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4328
Practice Address - Country:US
Practice Address - Phone:561-691-4301
Practice Address - Fax:561-691-4517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92306261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAD132Medicare PIN
FLH84163Medicare UPIN