Provider Demographics
NPI:1730122417
Name:SHORE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:SHORE HEALTH SERVICES INC
Other - Org Name:SHORE CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-414-8765
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:NASSAWADOX
Mailing Address - State:VA
Mailing Address - Zip Code:23413-0802
Mailing Address - Country:US
Mailing Address - Phone:757-414-8355
Mailing Address - Fax:757-414-8034
Practice Address - Street 1:10085 WILLIAM F BERNART CIRCLE
Practice Address - Street 2:
Practice Address - City:NASSAWADOX
Practice Address - State:VA
Practice Address - Zip Code:23413
Practice Address - Country:US
Practice Address - Phone:757-414-8355
Practice Address - Fax:757-414-8034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHORE HEALTH SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-13
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID #
C00228Medicare ID - Type Unspecified
VAC00228Medicare PIN