Provider Demographics
NPI:1013908490
Name:VERO BEACH HEMATOLOGY ONCOLOGY, PA
Entity Type:Organization
Organization Name:VERO BEACH HEMATOLOGY ONCOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEMA
Authorized Official - Middle Name:NAGANEMI
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-299-4255
Mailing Address - Street 1:981 37TH PL
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6541
Mailing Address - Country:US
Mailing Address - Phone:772-299-4255
Mailing Address - Fax:772-299-3580
Practice Address - Street 1:981 37TH PL
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6541
Practice Address - Country:US
Practice Address - Phone:772-299-4255
Practice Address - Fax:772-299-3580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0077699261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCJ7577OtherRAILROAD MEDICARE GRP
FL45956OtherBLUE SHIELD GROUP
FLCJ7577OtherRAILROAD MEDICARE GRP
FL45956Medicare ID - Type UnspecifiedMEDICARE GROUP