Provider Demographics
NPI:1356302178
Name:BERKS HEMATOLOGY ONCOLOGY ASSOC LTD
Entity type:Organization
Organization Name:BERKS HEMATOLOGY ONCOLOGY ASSOC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEASURE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-374-4404
Mailing Address - Street 1:PO BOX 16052
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-6052
Mailing Address - Country:US
Mailing Address - Phone:610-374-4404
Mailing Address - Fax:610-374-1396
Practice Address - Street 1:S 6TH AVE & SPRUCE ST
Practice Address - Street 2:TRHMC REGIONAL CANCER CENTER N-GROUND
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611
Practice Address - Country:US
Practice Address - Phone:610-374-4404
Practice Address - Fax:610-374-1396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA291U00000X
207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006470190001Medicaid
CF2026OtherRAILROAD MEDICARE
20015378OtherAMERIHEALTH MERCY
0020506000OtherAMERIHEALTH 65
PA02412800OtherCAPITAL BLUE CROSS
PA021912OtherHIGHMARK BLUE SHIELD
PA02412800OtherCAPITAL BLUE CROSS
PA021912Medicare ID - Type Unspecified