Provider Demographics
NPI:1598877813
Name:ALLIANCE CANCER SPECIALISTS
Entity Type:Organization
Organization Name:ALLIANCE CANCER SPECIALISTS
Other - Org Name:MAIN LINE ONCOLOGY HEMATOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DISTASIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-645-2494
Mailing Address - Street 1:100 E LANCASTER AVENUE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:610-645-2494
Mailing Address - Fax:610-645-4456
Practice Address - Street 1:100 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-645-2494
Practice Address - Fax:610-645-4456
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONSULTANTS IN MEDICAL ONCOLOGY & HEMATOLOGY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMC542764A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA919262Medicaid
000279824OtherBLUE SHIELD
0094364000OtherBLUE CROSS
PA919262Medicaid
028114Medicare ID - Type Unspecified