Provider Demographics
NPI:1831103795
Name:TRI-STATE REGIONAL CANCER CENTER
Entity Type:Organization
Organization Name:TRI-STATE REGIONAL CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANJAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BHANDARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-385-0404
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-5200
Mailing Address - Country:US
Mailing Address - Phone:330-385-0404
Mailing Address - Fax:
Practice Address - Street 1:15898 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9122
Practice Address - Country:US
Practice Address - Phone:330-385-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001323569OtherMOUNTAIN STATE BLUE SHIEL
OH1537613Medicaid
WV001323569OtherMOUNTAIN STATE BLUE SHIEL
OHTR9354001Medicare PIN