Provider Demographics
NPI:1639215114
Name:OHIO CANCER SPECIALISTS
Entity Type:Organization
Organization Name:OHIO CANCER SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:DEWALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-342-2775
Mailing Address - Street 1:371 CLINE AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1021
Mailing Address - Country:US
Mailing Address - Phone:419-756-2122
Mailing Address - Fax:419-756-3530
Practice Address - Street 1:31 E MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1262
Practice Address - Country:US
Practice Address - Phone:419-342-2775
Practice Address - Fax:419-342-2237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2411170Medicaid
OH2411170Medicaid