Provider Demographics
NPI:1598866394
Name:ONCOLOGY HEMATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:ONCOLOGY HEMATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:J
Authorized Official - Last Name:COONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-842-9800
Mailing Address - Street 1:327 MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9006
Mailing Address - Country:US
Mailing Address - Phone:304-842-9800
Mailing Address - Fax:304-842-9804
Practice Address - Street 1:327 MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9006
Practice Address - Country:US
Practice Address - Phone:304-842-9800
Practice Address - Fax:304-842-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9922112Medicare ID - Type Unspecified