Provider Demographics
NPI:1790754083
Name:HEMATOLOGY ONCOLOGY OF SALEM CORP LLC
Entity Type:Organization
Organization Name:HEMATOLOGY ONCOLOGY OF SALEM CORP LLC
Other - Org Name:HEMATOLOGY ONCOLOGY OF SALEM CORP LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZORAIDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-332-7672
Mailing Address - Street 1:PO BOX 22925
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-0925
Mailing Address - Country:US
Mailing Address - Phone:330-332-5306
Mailing Address - Fax:330-332-7674
Practice Address - Street 1:1995 E STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2423
Practice Address - Country:US
Practice Address - Phone:330-332-7672
Practice Address - Fax:330-332-7674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-17
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDA6849OtherMEDICARE RAILROAD
OH383695927OtherTRICARE
OH383695927OtherTRICARE
OHDA6849OtherMEDICARE RAILROAD
OH9341631Medicare PIN